[Upper gastrointestinal bleeding after long term, high dose NSAID medication: a wolf in sheep's clothing?].
A 71-year-old patient with melena, abdominal and lower back pain was admitted to hospital under suspicion of upper gastrointestinal bleeding. He had mild anemia and an elevated C-reactive protein. Endoscopy and ultrasound failed to localize the source of bleeding. The patient died 2 1/2 days after admission on an exsanguinating hemorrhage. On pathologic examination a fistula between the small aortic aneurysm and duodenum and periaortic inflammation in contact with a spondylitis were found. When clinical presentation is subtle, with a herald bleeding followed by a period of grace, the diagnosis of aortoenteric fistula may be extremely difficult.
Sinicina
I
I
Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München. inga.sinicina@rects.med.uni-muenchen.de
Matevossian
E
E
Mall
G
G
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000473:pathology*; D001416:Back Pain / Q000188:drug therapy; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000473:pathology*; D008297:Male
D000894:Anti-Inflammatory Agents, Non-Steroidal