Abstract
BACKGROUND: Inferior mesenteric arteriovenous fistula (IMAVF) is an extremely rare condition characterized by abnormal communication between the inferior mesenteric artery and vein. IMAVF often mimics ischemic bowel disease and ulcerative colitis (UC), leading to diagnostic challenges and treatment failures. CASE SUMMARY: Three consecutive cases presented with non-specific symptoms including perianal pain and bloody diarrhea were reported. Initial diagnosis included acute severe UC and ischemic colitis. Pathology suggested ischemic changes, and with further contrast-enhanced computed tomography together with digital subtraction angiography which confirmed the diagnosis of IMAVF. All three cases were treated by vascular embolization, and symptoms improved rapidly following treatment. CONCLUSION: We presented the largest single center IMAVF series with detailed clinical characteristics, facilitating early diagnosis for similar cases in the future.