A patient with lower gastrointestinal bleeding: common history, very uncommon cause, minimally invasive treatment

Abstract

An 81-year-old patient with significant cardiac comorbidities, a history of sigmoid resection 6 years ago, and iliac bypass surgery 19 years ago presented with mild hematochezia for the previous 3 days. While hemodynamically stable at first, he developed massive bleeding during preparation for colonoscopy and underwent a short course of cardiopulmonary resuscitation. Colonoscopy revealed no active bleeding but a protuberance of the colonic wall and a coagulation clot. In ultrasonography immediately after endoscopy, a large aneurysm was diagnosed and diagnosis of an iliaco-colonic fistula was assumed. CT scan demonstrated a large pseudoaneurysm of the distal anastomosis after iliaco-iliac bypass. With endovascular treatment, the original lumen of the iliac artery could be recanalized, and 2 covered stents were placed to cover both anastomosis of the prosthetic bypass leading to a complete shutdown of bypass perfusion. A double-barreled transversostoma was established to minimize contamination of the aneurysmal sac. Seven months after these procedures, the patient is well and free of infection.Though aorto- or iliaco-colonic fistula after aortic or iliac surgery are very rare, endoscopists should be aware of their possibility. A high index of clinical suspicion in patients with prior abdominal vascular bypass surgery should prompt rapid imaging studies, possibly before endoscopy. In critically ill patients, endovascular treatment may be a suitable alternative and result in a favorable outcome.

Zone 2/3 lesion and emergency repair as potential mortality predictors of TEVAR for thoracic aortic pseudoaneurysm

“…In our series, TAP with massive hemoptysis, haematemesis or hematochezia was indications for emergent TEVAR, besides ruptured descending thoracic aortic aneurysms, acute BTAI and complicated acute type B aortic dissections [ 42 ]. Massive hemoptysis, haematemesis or hematochezia occurred due to aortopulmonary fistula (APF) or AEF even with a visible intrabronchial or intraesophageal mass [ 26 , 43 – 48 ]. There was no detectable APF in our patients manifested as hemoptysis, albeit in one patient who complained of persistent hemoptysis for even seven years after TEVAR.…”

Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

“…Actually, hemoptysis, hematemesis, hematochezia and melena are strikingly noticeable as quite common symptoms of respiratory and digestive diseases. They occurred due to aortopulmonary stula (APF) or AEF even with a visible intrabronchial or intraesophageal mass (24,(32)(33)(34)(35)(36)(37). In such situations, endoscopic clamping biopsy poses a risk of massive bleeding.…”