Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7162-7169
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7162
Rare finding of primary aortoduodenal fistula on single-photon emission computed tomography/computed tomography of gastrointestinal bleeding: A case report
Chun-Liang Kuo, Ching-Fu Chen, Wen-Ko Su, Rong-Hsin Yang, Yu-Hong Chang
Chun-Liang Kuo, Rong-Hsin Yang, Yu-Hong Chang, Department of Nuclear Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
Ching-Fu Chen, Department of Gastroenterology, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
Wen-Ko Su, Department of Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
Author contributions: Kuo CL collected the patient’s clinical data and wrote the paper; Chen CF, Su WK, and Yang RH performed the patient’s diagnosis; Kuo CL and Chang YH contributed equally to this work; All authors have read and approved the final version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Hong Chang, MD, Doctor, Department of Nuclear Medicine, Hsinchu Mackay Memorial Hospital, No. 690 Guangfu Road, Hsinchu 30071, Taiwan. 3053@mmh.org.tw
Received: June 27, 2023
Peer-review started: June 27, 2023
First decision: August 20, 2023
Revised: September 1, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: October 16, 2023
Processing time: 108 Days and 12.9 Hours
Abstract
BACKGROUND

Primary aortoduodenal fistula is a rare cause of gastrointestinal (GI) bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage.

CASE SUMMARY

A 67-year-old man was hospitalized for coffee ground vomiting, tarry stools, and colic abdominal pain. He was repeatedly admitted for active GI bleeding and hypovolemic shock. Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy, angiography, computed tomography angiography (CTA), capsule endoscopy, and 99mTc-labeled red blood cell (RBC) scans. The patient received supportive treatment and was discharged without signs of rebleeding. Thereafter, he was re-admitted for bleeder identification. Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum. A 99mTc-labeled RBC single-photon emission CT (SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level. According to his clinical symptoms (intermittent massive GI bleeding with hypovolemic shock, dizziness, dark red stool, and bloody vomitus) and the abdominal CTA and 99mTc-labeled RBC SPECT/CT results, we suspected a small aneurysm and an aortoduodenal fistula. Subsequent duodenal excision and duodenojejunal anastomosis were performed. A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified. Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved.

CONCLUSION

Our findings suggest that 99mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.

Keywords: Gastrointestinal active bleeding; Computed tomography angiography; 99mTc-labeled red blood cell scan; Single-photon emission computed tomography/computed tomography; Primary aortoduodenal fistula; Case report

Core Tip: We describe a 67-year-old man was recurrently admitted due to gastrointestinal (GI) active bleeding and hypovolemic shock. According to clinical symptoms, abdominal computed tomography (CT) angiography, and 99mTc-red blood cell single-photon emission CT/CT scan, duodenal bleeding may be caused by the small aneurysm, and primary aortoduodenal fistula was highly suspected. Then he underwent duodenum excision and duodenum-jejunum anastomosis. The symptoms of GI bleeding improved postoperatively.