title: Arterioenteric Fistulae Due to Pseudoaneurysms of the Right Common Iliac and Splanchnic Vessels Presenting as Upper GI Bleed.
abstract: Arterial pseudoaneurysms are relatively rare complications of the vascular system. Many cases may remain asymptomatic for a lifetime only to be discovered incidentally, whereas others may cause fatal hemorrhage. Majority of cases present with local compressive symptoms. Rarely, it has been implicated as an etiology for gastrointestinal (GI) bleed by eroding into an adjacent bowel, with splanchnic pseudoaneurysm being more commonly responsible as compared to peripheral ones. Although rare, they are an important consideration because of the high mortality rate. They require a high index of suspicion with prompt diagnosis and expedient treatment, either surgical or endovascular. In this study, we report a case series of a right iliacoduodenal and 2 splanchnic pseudoaneurysms presenting as upper GI bleeding. These 3 cases presented with occult source of hematemesis due to the formation of arterioenteric fistula. Also discussed are the diagnostic approach used and successful treatment methods, which included placing endoprosthesis in the aorta and common iliac artery and endovascular coiling for respective cases. To the best of our knowledge, such a case of common iliac pseudoaneurysm presenting with massive hematemesis due to fistulization into duodenum has never been reported previously.
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Prashant R
authors.initials: PR
authors.lastname: Rao
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India bdthombre@gmail.com.
authors.forename: Bhushan D
authors.initials: BD
authors.lastname: Thombre
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Dandekar
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Rajinder
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Surgery, TNMC and BYL Nair Ch. Hospital, Mumbai, Maharashtra, India.
authors.forename: Rajeev M
authors.initials: RM
authors.lastname: Joshi
mesh_terms: D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D000072226:Computed Tomography Angiography; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D057510:Endovascular Procedures; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006396:Hematemesis / Q000209:etiology; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D013270:Stomach / Q000098:blood supply*; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy
keywords: GI bleed; iliacal–duodenal fistula; peripheral arterial pseudoaneurysm; splanchnic pseudoaneurysm