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Critical presentation and management of an acute gastrointestinal haemorrhage as a result of an arterioenteric fistula secondary to a failed pancreatic allograft
  1. Anastasia Naritsin1 and
  2. Jessica Peck2
  1. 1Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  2. 2Emergency Department, Southern New Hampshire Medical Center, Nashua, New Hampshire, USA
  1. Correspondence to Dr Anastasia Naritsin; anastasia.naritsin{at}gmail.com

Abstract

We present a case of a 60-year-old woman status post failed pancreatic transplant, presenting with right lower extremity pain and large volume rectal bleeding. The team initiated a massive transfusion protocol. Investigations revealed an arterioenteric (AE) fistula between the right external iliac artery and terminal ileum. The patient was then emergently sent for right iliac artery stent placement, successfully stopping the active arterial haemorrhage. Afterwards, the surgical team transected the pancreatic jejunal anastomosis, subsequently resecting 7 cm of jejunum. On postoperative day 1, the patient became unstable, going into disseminated intravascular coagulation evidenced by low platelet count, elevated prothrombin time and bloody output from multiple sites. Resuscitation with pressors and blood product transfusion was unsuccessful. She was made comfort measures only and expired shortly after extubation. Although a rare aetiology, it is important to consider AE fistulas in patients presenting with vascular and gastrointestinal symptoms in the setting of a failed allograft.

  • diabetes
  • gi bleeding
  • pancreas and biliary tract
  • vascular surgery
  • transplantation

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Footnotes

  • Contributors AN has done the research and drafted the manuscript as well as participated in contacting the next of kin, obtaining consent and gathering the medical records. AN was also present and participated in the case itself. JP was the supervisor and participated in reviewing the draft. She was also the lead attending for the case and authored the emergency department note.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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