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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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Autores principales: Desai, Nirmit, Patel, Sagar, Nwosu, Chinyere, Sung, Lok, Tack, Carl, Buscaglia, Jonathan M., Nord, Edward P., Wadhwa, Nand K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886212/
https://www.ncbi.nlm.nih.gov/pubmed/24455393
http://dx.doi.org/10.1155/2013/171807
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author Desai, Nirmit
Patel, Sagar
Nwosu, Chinyere
Sung, Lok
Tack, Carl
Buscaglia, Jonathan M.
Nord, Edward P.
Wadhwa, Nand K.
author_facet Desai, Nirmit
Patel, Sagar
Nwosu, Chinyere
Sung, Lok
Tack, Carl
Buscaglia, Jonathan M.
Nord, Edward P.
Wadhwa, Nand K.
author_sort Desai, Nirmit
collection PubMed
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.
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spelling pubmed-38862122014-01-22 Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft Desai, Nirmit Patel, Sagar Nwosu, Chinyere Sung, Lok Tack, Carl Buscaglia, Jonathan M. Nord, Edward P. Wadhwa, Nand K. Case Rep Transplant Case Report 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. Hindawi Publishing Corporation 2013 2013-12-25 /pmc/articles/PMC3886212/ /pubmed/24455393 http://dx.doi.org/10.1155/2013/171807 Text en Copyright © 2013 Nirmit Desai et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Desai, Nirmit
Patel, Sagar
Nwosu, Chinyere
Sung, Lok
Tack, Carl
Buscaglia, Jonathan M.
Nord, Edward P.
Wadhwa, Nand K.
Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft
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
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886212/
https://www.ncbi.nlm.nih.gov/pubmed/24455393
http://dx.doi.org/10.1155/2013/171807
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