Fever and haematochezia: an unusual association

Antunes, Artur Gião; Peixe, Bruno; Guerreiro, Horacio

http://hdl.handle.net/10400.1/9382

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Authors

Antunes, Artur Gião

Peixe, Bruno

Guerreiro, Horacio

Abstract(s)

A 72-year-old male patient presented to the emergency room for haematocheziafollowed bysyncope. In the past 2 days he had fever and asthenia. From his medical records, we registered a peripheral vascular disease, with an aortobifemoral bypass graft placed 12 years prior; 6 years later, the graft had a thrombosis event and the patient was submitted to an axillofemoral bypass graft. On physical examination, he had haemodynamic instability and fever (38°C); the abdominal examination showed no abnormalities. Laboratory tests were as follows: haemoglobin: 10.7 g/L, white cell count: 17.7×109/ L; international normalized ratio (INR): 6.26; C reactive protein: 202 mg/L; blood urea nitrogen (BUN): 44 U/L; and creatinine: 1.91 mg/dL. After haemodynamic resuscitation, given the clinical presentation and the hypothesis of secondary aortoenteric ﬁstula (AEF), a CT angiography was performed (ﬁgure 1). Although no active bleeding was detected, the aortobifemoral bypass graft was found to be adjacent to the third part of duodenum, but at a level at which the lumen of the aorta was partially thrombosed. Also, an effacement of the fat plane between the graft and the adjacent portion of the duodenum was noticed.