[Aorto-intestinal fistula versus angiodysplasia. A difficult differential diagnosis in gastrointestinal bleeding].
A 63-year-old patient had recurrent tarry stools and haemoglobin levels of around 7.0 g/dl. Ten years previously he had undergone an aortobifemoral bypass operation for peripheral vascular disease in the legs. Eight gastroscopies and five coloscopies over ten weeks failed to discover a bleeding source. Although an aorto-intestinal fistula was considered early on, extensive diagnostic tests failed to reveal it. Digital subtraction angiography was suggestive of an angiodysplasia of the terminal ileum, a diagnosis supported when coloscopy during exploratory laparotomy visualized blood trickling from the terminal ileum. As a result of this finding a right hemicolectomy was performed. But recurrent bleedings necessitated relaparotomy which finally revealed a fistula between the ascending duodenum and the proximal bypass graft anastomosis. Nine months after resection of the proximal anastomotic area and interposition of a Dacron prosthesis the patient has been free of symptoms.
Kling
N
N
Abteilung für Allgemeinchirurgie, Universitätsklinikum Rudolf Virchow, Deutsches Herzzentrum, Berlin.
Keck
H
H
Schiessler
A
A
Hasselbeck
T
T
Langer
R
R
Neuhaus
P
P
D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001012:Aorta, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003082:Colectomy; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004386:Duodenum / Q000601:surgery; D005402:Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D007412:Intestinal Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation