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Lower intestinal bleeding due to aorto-enteric fistula.
C Maiolo1, S Caprioglio, G Cadario
1Division of Internal Medicine, S. Andrea Hospital, Vercelli, Italy.
Summary
A rare diagnosis of anaerobic aortic graft infection was made using a labeled white cell scan. This infection caused intermittent fever, fatigue, and occult intestinal bleeding due to an aorto-jejunal fistula.
Area of Science:
- Infectious Diseases
- Diagnostic Imaging
- Gastroenterology
Background:
- Aortic graft infections are serious complications following aortic prosthesis surgery.
- Intermittent fever and fatigue can be non-specific symptoms, complicating diagnosis.
Observation:
- A patient presented with persistent fever and fatigue, unresponsive to initial investigations.
- Multiple diagnostic procedures including digestive endoscopies and computed tomography were performed.
- A 99m technetium-HM-PAO-labelled white cell scan proved crucial for diagnosis.
Findings:
- The diagnostic workup revealed anaerobic aortic graft infection.
- The patient also had anemia secondary to intermittent occult intestinal bleeding.
- A secondary aorto-jejunal fistula was identified as the cause of the intestinal bleeding.
Implications:
- This case highlights the utility of labeled white cell scans in diagnosing rare aortic graft infections.
- Clinicians should consider aorto-jejunal fistula in patients with aortic prostheses presenting with unexplained fever and occult gastrointestinal bleeding.
- Early and accurate diagnosis is critical for managing aortic graft infections and associated complications.