Marginal Artery of Drummond Pseudoaneurysm Masquerading as Fistulous Tract Resulting in Recurrent Lower Gastrointestinal Bleeding
American Journal of Gastroenterology
; 117(10 Supplement 2):S1735, 2022.
Artículo
en Inglés
| EMBASE | ID: covidwho-2321937
ABSTRACT
Introduction:
The mortality rate of patients hospitalized with a lower gastrointestinal bleed has been reported at 1.1% in the United States from 2005 to 2014. Pseudoaneurysms, typically associated with pancreatitis, have been described in case reports as a rare condition with a small subset presenting as gastrointestinal bleeding. Our study describes a rare case of recurrent lower gastrointestinal bleeding diagnosed as a pseudoaneurysm by endoscopy and angiography. Case Description/Methods:
A 38-year-old male presented to our facility from a long-term care facility with hematochezia and blood clots per gastrostomy-jejunostomy. He had recently been hospitalized for severe coronavirus disease 2019 with a complicated hospital course in the intensive care unit including necrotizing pancreatitis with an abdominal drain, multiple secondary infections, tracheostomy, and percutaneous endoscopic gastrostomy-jejunostomy. On previous hospitalization, he was found to have a small pseudoaneurysm of the gastroduodenal artery and received embolization of the gastroduodenal and gastroepiploic arteries at that time. During transport to our hospital, he was noted to have tachycardia, hypotension requiring norepinephrine, and was transfused one unit of red blood cells. Hemoglobin at this time was 7.5 g/dl after transfusion. Esophagogastroduodenoscopy was completed and showed a gastrojejunostomy tube in the expected location but was noted to be tight to the mucosa, which was pale in appearance. Flexible sigmoidoscopy revealed localized areas of edematous and erythematous mucosa with some associated oozing throughout the sigmoid colon. Repeat evaluation was completed one week later due to recurrent hematochezia. Colonoscopy was performed with identification of an apparent fistulous tract in the sigmoid colon located at 35 cm. Computed tomography angiography localized a pseudoaneurysm arising from the marginal artery of Drummond just proximal to its anastomosis with the ascending branch of the left colic artery and was successfully embolized. Discussion(s) Pseudoaneurysms, such as the one described in this case, have been shown to be associated with pancreatitis and can result if a pseudocyst involves adjacent vasculature. Gastrointestinal bleeding is a rare presentation of this condition. However, this case highlights the importance of repeat colonoscopy and angiography in the setting of a lower gastrointestinal bleed of unknown etiology.
abdominal drain; acute hemorrhagic pancreatitis; adult; anastomosis; artificial embolization; blood clot; case report; clinical article; colonoscopy; computed tomographic angiography; conference abstract; coronavirus disease 2019; endoscopy; erythrocyte; esophagogastroduodenoscopy; false aneurysm; gastroduodenal artery; gastroepiploic artery; gastrointestinal hemorrhage; gastrojejunostomy tube; gastrostomy; hematochezia; hospitalization; human; human cell; hypotension; intensive care unit; jejunostomy; left colic artery; lower gastrointestinal bleeding; male; mucosa; nursing home; pancreatitis; percutaneous endoscopic gastrostomy; pseudocyst; secondary infection; sigmoid; sigmoidoscopy; surgery; tachycardia; tracheostomy; vascularization; endogenous compound; hemoglobin; noradrenalin
Texto completo:
Disponible
Colección:
Bases de datos de organismos internacionales
Base de datos:
EMBASE
Tipo de estudio:
Estudio de etiologia
/
Estudio experimental
/
Estudio pronóstico
Idioma:
Inglés
Revista:
American Journal of Gastroenterology
Año:
2022
Tipo del documento:
Artículo
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