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History: The patient is a
47-year-old white male who has a long history of peripheral vascular
disease and is status post aortobifemoral bypass with graft in the
past. He presented to the hospital with non-GI complaints such as
leg pain, etc. He was later found to have melena. The patient
had an episode of hematochezia and the NG tube lavage was positive
for bright red blood. He was monitored in the ICU and resuscitated
as required. We proceeded after obtaining informed consent from the
patient's sister for this procedure which was medically necessary at
this moment in time. A CT angiogram had shown a significant
possibility of an aortoenteric fistula and the bleeding scan was
positive.
Radiology Report
AUTOLOGOUS RED BLOOD CELL
TECHNETIUM-LABELED BLEEDING SCAN
09/12/06
CLINICAL INDICATION: Patient with gastrointestinal bleed for
localization.
PROCEDURE: The patient was injected with 29.7mCi autologous
Technetium-labeled red blood cells.
FINDINGS: Real time acquisition was performed over the abdomen and
pelvis following injection of the radio-labeled red blood cells. An
area of bleeding appears promptly in the left upper quadrant of the
patient in small bowel. On correlation with the CT findings this
study is indicative of an aorto-enteric fistula. The study was
halted at this time, with the appropriate physicians notified of the
findings and diagnosis.
Hospital course: The
patient was taken emergently to the operating room for a repair of
the fistula. Overnight
his stenosis in the lower left extremity started to get worse and
his leg continued not to have any signals. He was taken back
to surgery for revascularization of his left leg. The patient
remains in ICU.
Teaching Note: An aorto-enteric
fistula is a direct communication between the aortic lumen and the
gastro-intestinal tract producing a gastro-intestinal bleeding.
Secondary aorto-enteric fistula (AEF) is a serious, but rare,
complication following surgery of the abdominal aorta. AEF occurs in
0.3-2%, but is associated with a hospital mortality between 25-90%.
Early diagnosis and treatment are essential. AEF is also
associated with an important morbidity with a lower limb amputation
rate of 9%, and a 15% risk for renewed graft infection.
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