An unusual cause of distal duodenal bleeding.

Abstract

ing and a focus of infection in the small intestine were highly suspected by the infectious disease specialist. Capsule endoscopy demonstrated a foreign body with several V-shaped metallic wires coated on its surface in the third portion of the duodenum (Fig. A). Moreover, oozing of blood was identified in the vicinity of the foreign body (Fig. B). Abdominal X-ray showed a retained capsule in the right upper abdomen near a tortured aortic stent (Fig. C, arrow). What is your diagnosis of this foreign body? Question: A 63-year-old man was admitted to our hospital because of intermittent fever and anemia for 2 months. He was diagnosed as having abdominal aortic aneurysm rupture with an initial presentation of abdominal pain 4 months previously. He underwent emergency endovascular abdominal aortic aneurysm repair (EVAR) by using an aorto-bifemoral bypass graft. After EVAR, he developed intermittent fever, despite the administration of antibiotics. Blood culture yielded multiple bacterial species. Moreover, anemia with positive occult blood in stool was also found. Esophagogastroduodenoscopy and colonoscopy failed to