Open AccessAortoenteric fistula: a rare but critical cause of small bowel bleeding discovered on capsule endoscopy
Author(s) -
Matt Davie,
Diana E Yung,
John Plevris,
Anastasios Koulaouzidis
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-230083
Subject(s) - medicine , aortoenteric fistula , capsule endoscopy , bleed , surgery , abdominal aortic aneurysm , abdominal pain , radiology , endoscopy , stent , gastrointestinal bleeding , angiography , emergency department , aneurysm , psychiatry
A 78-year-old man attended for outpatient capsule endoscopy, to investigate a recent history of unexplained small bowel bleeding. His previous medical history included an abdominal aortic aneurysm repair 6 years ago. Soon after capsule ingestion, he experienced sudden onset abdominal pain and collapsed on hospital grounds. He was rapidly transferred to the emergency department as he was haemodynamically unstable, and a significant per rectum (PR) bleed was found on examination. The patient was quickly stabilised following fluid resuscitation. CT angiography was performed which did not show active bleeding. However, use of the real-time capsule viewer indicated a profuse active jejunal bleed originating from the aortic graft, suggestive of an aortoenteric fistula. The patient underwent emergency endovascular cuff placement, and subsequent endovascular abdominal aortic stent grafting, to good effect.