Common Iliac Arterial-Rectal Fistula Managed with Endovascular Stenting in a Patient with History of Pelvic External Beam Radiation

A 53-year-old black female, with a past medical history significant for hypertension, end-stage renal disease on hemodialysis, a chronic right atrial thrombus for which she was taking apixaban, and a history of locally advanced cervical cancer managed with neo-adjuvant chemotherapy, radiation therapy, and interval hysterectomy, presented originally to her local hospital complaining of profuse bright red blood per rectum. Before transfer to our facility, she was bloused with normal saline and transfused 2 units of packed red blood cells, and self-expanding polyvinyl acetate foam packing was placed in the rectal cavity in an attempt to tamponade the bleeding. Similar cases include a massive GI bleeding due to an arterial-colonic fistula connecting a pseudoaneurysm at the left external iliac to the sigmoid colon which was managed with arterial ligation and sigmoidectomy in a patient who underwent left orchiectomy and chemotherapy for a seminoma without radiation therapy in the past.3 Other reported cases include an arterialenteric fistula secondary to a perforation in the common iliac artery by a toothpick4 and a case series of arterial-enteric fistulas occurring after highdose pelvic irradiation, all of which were managed with bowel resection and ligation of the bleeding vessels.