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Session: ePoster: Benign Abdominal 1 (Sun8)

EP223 - Right Internal Iliac Artery to Sigmoid Fistula Secondary to Sigmoid Diverticulitis

Sunday, May 11, 2025
9:16 AM – 9:21 AM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Kendall Post, MD (she/her/hers)

    General Surgery Resident
    Allegheny Health Network
    Pittsburgh, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Richard Fortunato, DO (he/him/his)

    Program Director, Colorectal Fellowship
    Allegheny Health Network
    Drexel University College Of Medicine
    Pittsburgh, PA, United States

    Disclosure information not submitted.

    • Author(s)

  • SM

    Satish C. Muluk, MD

    System Director of Vascular Surgery
    Allegheny health Network
    Pittsburgh, Pennsylvania, United States

    Disclosure information not submitted.

  • VS

    Vei Shaun Siow, MD

    Vascular Surgeon
    Allegheny Health Network
    Pittsburgh, Pennsylvania, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Kendall Post, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Life threatening vascular complications of diverticulitis are rare and right internal iliac artery to sigmoid fistula has only been described twice in the literature. Most aorto- or iliac-sigmoid fistula cases previously reported are secondary to pelvic malignancy or radiation, with rare cases of diverticular disease or inflammatory bowel disease precipitating fistula. In cases related to diverticular disease, definitive management requires sigmoidectomy, but life-threatening bleeding may preclude upfront resection. We present the case of a right internal iliac artery to sigmoid colon fistula secondary to diverticulitis, treated with combined endovascular and surgical resection.

Methods/Interventions: A 70 year old male presented to the emergency department with 5 days of right groin pain and urinary retention. CT scan demonstrated a 4.1 x 5.0 cm saccular aneurysm arising from the right internal iliac artery and he was admitted to a vascular surgery service with plans for an endovascular repair the following day. However, overnight, he developed massive hematochezia with asystole related to an unrecognized internal iliac artery-sigmoid colon fistula. He required 6 units of packed blood, 4 minutes of cardiopulmonary resuscitation and eventually was recovered. The patient was taken for emergent endovascular stenting of his right common iliac and coiling of his right internal iliac artery. He fully recovered and was taken for exploratory laparotomy the following morning, which revealed diverticular disease and an abscess cavity between the rectosigmoid colon and right internal iliac artery. A Hartmann’s procedure was performed with intraoperative ligation of right internal iliac artery aneurysm.

Results/Outcomes: The patient recovered uneventfully and was discharged to a skilled nursing facility on post operative day 11.

Conclusion/Discussion: Diverticular disease is a rare etiology of life- threatening hematochezia. When present, aorto-iliac fistula must be considered. We present the case of a rare, right-sided internal iliac artery to sigmoid fistula from diverticulitis treated with an emergent bridge endovascular approach followed by a Hartmann resection for definitive management.