Aortoiliac endograft-enteric fistula due to an ingested toothpick

Abstract

Foreign body ingestion is not uncommon, but in most patients the object passes without sequelae. In very few patients, the ingested foreign objects may perforate the gastrointestinal tract, causing potentially life-threatening complications. Pointed ingested objects such as toothpicks are the most common. Vascular perforation due to toothpick ingestion has rarely been reported. We present a patient with lower gastrointestinal bleeding secondary to simultaneous perforation of the sigmoid colon and the right iliac limb of an aortobiiliac endograft by an ingested toothpick. This arterioenteric fistula was treated in two stages. First as a bridging operation, a stent graft was inserted into the ipsilateral limb of the previous aortoiliac endograft to control the bleeding. Second, the aortoiliac endograft was removed, the aorta was oversewn, and an extra-anatomic axillobifemoral bypass restored the flow to the lower limbs. The colon perforation was treated with a proximal temporary loop colostomy. To our knowledge, this the first case of aortoiliac endograft-enteric fistula after endovascular abdominal aortic aneurysm repair caused by this extraordinary mechanism.

Duodeno‐iliac fistula secondary to ingested toothpick

“…Firstly, it highlights the rare pathology of a duodeno‐iliac fistula following toothpick ingestion. Although there are previous reports of arterial‐enteric injury secondary to ingested toothpick (see Lazaris et al . for review), to our knowledge, this is the first case of duodeno‐iliac fistula secondary to toothpick in an otherwise healthy aorto‐iliac system.…”

Aortoenteric Fistula-An Uncommon Cause of Gastrointestinal Bleeding. A Review of the Literature

“…He observed a lethal communication between the aorta and gastrointestinal tract causing massive upper gastrointestinal bleeding. Two types are described: Primary and Secondary AEFs [6][7][8][9][10]. less common with an incidence of 0.1 to 0.8%, is due to the erosion of the intestinal wall by the aortic aneurysm in the presence of predisposing factors such as atherosclerosis (60-80% of cases), infections (e.g., syphilis and tuberculosis), collagen diseases, cancer (lymphoma) or mechanical stress (e.g., biliary calculi, ulcers, or radiation) (Figure 1).…”

Trans-colonic foreign body penetration of the retro-hepatic vena cava. Report of a case and review of the literature

“…Cases of migration to the aorta, pericardium, coronary artery, lung, liver, portal vein, hepatoduodenal ligament, inferior vena cava, peritoneum, bladder, retroperitoneum, pancreas, kidney, ureter, perianal space, and hip have all been documented [14] . Although migration to other organs was previously described in the English literature direct penetration and impalement of the retro-hepatic vena cava was anecdotally described [15] , [16] , [17] , [18] , [19] , [20] , [21] .…”