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Massive bleeding due to arterial-enteric fistula from an ingested toothpick.
Journal of Clinical Gastroenterology
|August 1, 1985
Summary
A swallowed toothpick caused a rare arterial-enteric fistula, leading to severe lower gastrointestinal bleeding. Diagnosis was confirmed using vasopressin-enhanced arteriography, revealing the toothpick
Area of Science:
- Gastroenterology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Massive lower gastrointestinal bleeding necessitates prompt diagnosis and intervention.
- Initial diagnostic attempts, including upper endoscopy and superior mesenteric arteriography, can be inconclusive.
Observation:
- A 62-year-old male presented with severe lower GI bleeding.
- The bleeding source remained unidentified after initial endoscopic and angiographic evaluations.
Findings:
- Rebleeding prompted repeat arteriography with intra-arterial vasopressin infusion.
- Vasopressin infusion facilitated visualization of an arterial-enteric fistula.
- Exploratory laparotomy identified a toothpick perforating the small bowel and common iliac artery.
Implications:
- This case highlights a rare cause of gastrointestinal hemorrhage.
- Vasopressin-enhanced arteriography can be crucial for diagnosing obscure vascular lesions.
- Foreign body ingestion, even seemingly innocuous items like toothpicks, can lead to life-threatening complications.