Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft
We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) a...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2013/171807 |
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| author | Nirmit Desai Sagar Patel Chinyere Nwosu Lok Sung Carl Tack Jonathan M. Buscaglia Edward P. Nord Nand K. Wadhwa |
| author_facet | Nirmit Desai Sagar Patel Chinyere Nwosu Lok Sung Carl Tack Jonathan M. Buscaglia Edward P. Nord Nand K. Wadhwa |
| author_sort | Nirmit Desai |
| collection | DOAJ |
| description | We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC) imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population. |
| format | Article |
| id | doaj-art-eaa4ba204b244c2fab72bf6f151c2607 |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-eaa4ba204b244c2fab72bf6f151c26072025-02-03T05:45:34ZengWileyCase Reports in Transplantation2090-69432090-69512013-01-01201310.1155/2013/171807171807Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas AllograftNirmit Desai0Sagar Patel1Chinyere Nwosu2Lok Sung3Carl Tack4Jonathan M. Buscaglia5Edward P. Nord6Nand K. Wadhwa7Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USADivision of Nephrology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USADivisions of Gastro-Enterology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USADepartment of Radiology, Stony Brook Medicine, Stony Brook, NY 11794, USADepartment of Radiology, Stony Brook Medicine, Stony Brook, NY 11794, USADivisions of Gastro-Enterology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USADivision of Nephrology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USADivision of Nephrology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY 11794, USAWe present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC) imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population.http://dx.doi.org/10.1155/2013/171807 |
| spellingShingle | Nirmit Desai Sagar Patel Chinyere Nwosu Lok Sung Carl Tack Jonathan M. Buscaglia Edward P. Nord Nand K. Wadhwa Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft Case Reports in Transplantation |
| title | Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft |
| title_full | Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft |
| title_fullStr | Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft |
| title_full_unstemmed | Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft |
| title_short | Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft |
| title_sort | arteriojejunal fistula presenting with recurrent obscure gi hemorrhage in a patient with a failed pancreas allograft |
| url | http://dx.doi.org/10.1155/2013/171807 |
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