Clin Endosc.  2013 Jan;46(1):106-109. 10.5946/ce.2013.46.1.106.

Aortoenteric Fistula Diagnosed by Double Balloon Enteroscopy: A Case Report

• Yoon HG
• Ko BM
• Tae JW
• Hong SJ
• Moon JH
• Kim JO
• Lee JS
• Lee MS

• KMID: 1792651
• DOI: http://doi.org/10.5946/ce.2013.46.1.106

Abstract

A secondary aortoenteric fistula (AEF) is a direct communication between the gastrointestinal tract and the aorta in a patient who has undergone major surgery on the aorta, often an aorta graft operation. We experienced a patient who had undergone graft interposition for abdominal aortic aneurysm and was admitted due to three episodes of hematemesis and following hamatochezia. Gastroscopy, colonoscopy, and radioactive iodine scan failed to identify the bleeding site in the patient. He was diagnosed with AEF by double balloon enteroscopy and recovered after surgical intervention.

Keyword

Aortoenteric fistula; Double-balloon enteroscopy

MeSH Terms

Aorta
Aortic Aneurysm, Abdominal
Colonoscopy
Double-Balloon Enteroscopy
Fistula
Gastrointestinal Tract
Gastroscopy
Hematemesis
Hemorrhage
Humans
Iodine
Lymphokines
Transplants
Iodine
Lymphokines

Figure

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  Fig. 1 Double balloon enteroscopic finding. Neutral endoscopic view showed central erosion with silk.

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  Fig. 2 Double balloon enteroscopic finding. Retroflexion view of endoscopy showed flat elevated lesion with silk in the central erosion.

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  Fig. 3 Computed tomography (CT) findings. (A) The sagittal CT scan during arterial phase of contrast enhancement shows focal thickening and irregularity of the aortic wall, but not direct extravasation of contrast material. (B) On the delayed coronal CT scan obtained 4 minutes after the initial contrast injection shows markedly dilated proximal small bowel loops (black arrow) filled with high density of fluid suggesting active bleeding to the bowel lumen.

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  Fig. 4 Angiographic findings. The angiography showed direct fistula (white arrow) from aorta to the small bowel at abdominal aorta.

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