Massive Bleeding Due to Arterial-Enteric Fistula from an Ingested Toothpick

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A 62-year-old man developed massive lower gastrointestinal tract bleeding. Upper endoscopy and superior mesenteric arteriography initially failed to disclose a cause of bleeding. On rebleeding, intra-arterial vasopression infusion during repeated arteriography caused reflux of dye into the iliac vessels to allow visualization of an arterial-enteric fistula. Exploratory laparotomy subsequently revealed perforation of the small bowel and common iliac artery by a toothpick which had been swallowed.

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