Duodeno‐iliac fistula secondary to ingested toothpick

Abstract

Duodeno-iliac fistula secondary to ingested toothpickA 60-year-old female presented to a community hospital following massive haematemesis and collapse, with systolic pressure of 60 mmHg. She had an unremarkable medical background with no risk factors for gastrointestinal bleeding or previous aortic surgery.On presentation, abdominal and rectal exams were unremarkable. She underwent resuscitation and proton-pump inhibitor infusion but subsequently suffered circulatory collapse, requiring cardiopulmonary resuscitation and intubation. Emergency gastroscopy demonstrated bleeding in the second part of the duodenum, which was treated with an adrenaline injection and clipping.She remained unstable despite resuscitation and inotropes, and computed tomography angiogram demonstrated a blush from the right common iliac artery into the second part of the duodenum (Fig. 1). She was transferred to our institution for management of the duodeno-iliac fistula (Fig. 2a). An Endurant II bifurcated endograft was deployed, with completion angiography demonstrating no extravasation from the right common iliac artery (Fig. 2b). She recovered well and received 48-h Piperacillin/Tazobactam for prophylaxis. Subsequent gastroscopy revealed a foreign body protruding into the duodenum. A total of 11 days after presentation, she © 2017 Royal Australasian College of Surgeons ANZ J Surg 88 (2018) E807-E808