PMC3572345_01
Double balloon enteroscopic finding. Neutral endoscopic view showed central erosion with silk.
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F1
Immediately, we performed a DBE via the oral route, which disclosed flat elevated erosion with silk in the proximal jejunum (Fig. 1).
Double balloon enteroscopic finding. Retroflexion view of endoscopy showed flat elevated lesion with silk in the central erosion.
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F2
Endoscopic findings showed a fistula that opened and closed on the central portion (Fig. 2).
Computed tomography (CT) findings. (A) The sagittal CT scan during arterial phase of contrast enhancement shows focal thickening and irregularity of the aortic wall, but not direct extravasation of contrast material. (B) On the delayed coronal CT scan obtained 4 minutes after the initial contrast injection shows markedly dilated proximal small bowel loops (black arrow) filled with high density of fluid suggesting active bleeding to the bowel lumen.
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F3
The patient was finally diagnosed with secondary AEF by emergency multidetector computed tomography (MDCT) (Fig. 3) and angiographic findings (Fig. 4).