A patient with a secondary aorto-enteric fistula who presented with melena: a case report

Abstract

A 40-year-old man with a history of vascular graft implantation for abdominal artery aneurysm and a suspected graft infection presented to our hospital with melena for a few days. Laboratory data showed marked anemia (Hb 5.2 g/dl). There was no extravasation detected on enhanced CT images. We suspected diverticular bleeding and performed emergency colonoscopy but could not identify the bleeding site. To rule out excessive upper gastrointestinal bleeding, we performed an upper endoscopy and found that a wall of the graft was exposed to the duodenum. Emergency stent graft implantation was performed and the bleeding subsided. On day 10 after admission, we performed surgical repair of the fistula. For a patient presenting with melena with a history of surgical repair of an abdominal artery aneurysm, it is important to look for signs of secondary aorto-enteric fistula on enhanced CT imaging.