Massive bleeding due to arterial-enteric fistula from an ingested toothpick.
A 62-year-old man developed massive lower gastrointestinal tract bleeding. Upper endoscopy and superior mesenteric arteriography initially failed to disclose a cause of bleeding. On rebleeding, intra-arterial vasopressin infusion during repeated arteriography caused reflux of dye into the iliac vessels to allow visualization of an arterial-enteric fistula. Exploratory laparotomy subsequently revealed perforation of the small bowel and common iliac artery by a toothpick which had been swallowed.
D001157:Arterial Occlusive Diseases / Q000209:etiology*; D005547:Foreign Bodies / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007083:Iliac Artery / Q000473:pathology; D007412:Intestinal Fistula / Q000209:etiology*; D007416:Intestinal Perforation / Q000150:complications*; D007579:Jejunal Diseases / Q000209:etiology*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D011859:Radiography