Uso de una ‘cápsula endoscópica’ para el diagnóstico de fístulas aortoentéricas. A propósito de un caso

Abstract

Summary Introduction Aortoenteric fistulas or enteric erosion by prosthetic graft in the aortic territory in septic patients can be difficult to diagnose because of its, sometimes masked and insidious, clinical features, which makes early diagnosis one of the best guarantees when establishing a quick-acting effective therapy. Casereport Male aged 66 who had been submitted to surgery five years earlier for an aortobifemoral bypass because of an aorto-iliac occlusive pathology. At our centre he presented with a septic picture with a large retroperitoneal abscess detected by means of a computerised axial tomography (CAT) scan, and which covered the left branch of the graft. Suspected diagnosis was a secondary aortoenteric fistula caused by pressure from the duodenum on the graft, and the digestive tract was explored by using an ‘endoscopic capsule’, which consists in an encapsulated, disposable colour camera that shows images compatible with the direct visualisation of the graft through the opening of the duodenum. The diagnosis of enteric erosion by prosthetic graft was confirmed during the surgical intervention and the infected graft was removed with ligature of the aortic stump, following an axillo-bifemoral extra-anatomical bypass. The retroperitoneal abscess was also cleaned and drained at the same time. Conclusion The use of capsule endoscopy is considered to be a valid option and another possible method of diagnosis in the management of primary and secondary aortoenteric fistulas or enteric erosion by prosthetic grafts, together with classical endoscopy, when the lesions are located distally to the fourth portion of the duodenum or when other imaging techniques are not conclusive.