Introduction.

Arteriovenous malformations (AVM) simultaneously dependent on the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) are exceptionally rare. An arteriovenous fistula (AVF) is an aberrant communication between an artery and a vein. They can be congenital, acquired or idiopathic. The term AVM is used for congenital or idiopathic AVF.

Clinical case.

This is a male patient, 55 years old, with morbid obesity. The patient was tachycardic and had a painful abdomen in the left iliac fossa. The tomography in the emergency room and a subsequent CT angiography showed signs suggestive of ischemia. A giant AVM dependent mainly on the IMA is visualized with a large varicose dilation in the left colic vessel that drains into the splenic vein and is filled with contrast in the arterial phase. Colonoscopy biopsy showed compatibility with severe ischemic colitis. Deferred urgent surgery was decided after embolization, after which the patient presented exacerbation of abdominal pain and signs of peritoneal irritation and was transferred to the operating room.

Results.

A hemicolectomy with terminal colostomy was performed in the left iliac fossa. The postoperative period was uneventful.

Conclusion.

AVM dependent on the IMA and SMA are extremely rare, ours being the fourth case described in the literature. The scarcity of cases, the clinical variability and the severity of its complications make this pathology a diagnostic and therapeutic challenge and make it difficult to be dogmatic in the epidemiological characteristics and therapeutic recommendations.

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