Gastrointestinal bleeding due to aorto-enteric fistuale: Case report

Abstract

Two cases with aorto-bifemoral by-pass graft associated. Leriche Syndrome with recurrent gastrointestinal (GI) bleeding were presented. The first case was complaint about hematemesis and melena three times within the last three months. Upper GI endoscopy was urgently performed. The patient was immediately taken to the operation due to bleeding, seen at the third part of duodenum. In the laparotomy, a fistula was found between the pseudoaneurysm and the third part of the duodenum. The second case also had hematemesis and melena. Since pyloric ulcer was determined in the upper GI endoscopy during his initial hospitalization, bleeding was considered as from the ulcer. Because hematemesis and melena continued, laparotomy was performed. The fistula was found between the proximale suture line and the third part of duodenum. Unless otherwise proved, GI bleeding in patient with an abdominal aortic aneurysm or aortic graft should be considered as arterioenteric fistula. Upper GI endoscopy is helpful in detection of fistula and in differential diagnosis as well. Early explorative laparotomy may be life saving in severe active bleeding.