Arterioenteric fistula on a kidney graft site. A rare cause of massive lower gastrointestinal bleeding.

Arterioenteric fistula (AEF) on a kidney graft site is a rare cause of massive lower gastrointestinal bleeding (LGIB). Emergency angiography with concomitant endovascular repair is an efficient and safe approach in controlling the acute bleeding and stabilizing patients with life-threatening bleeding from AEF. We report a 42-year-old male who underwent allograft renal transplantation in the right iliac fossa 8 months before presenting with massive LGIB. Preoperative localization of the source of bleeding with mesenteric angiography was unsuccessful. He underwent laparotomy and intraoperative endoscopy, which localized the source of bleeding from the site of the grafted kidney. An anastomotic pseudoaneurysm was found connecting the ileum and the external iliac artery at the site of transplanted kidney. Resection of an ileal loop, nephrectomy of the rejected transplanted kidney, and primary repair of the external iliac artery were performed. Such patients should undergo selective mesenteric angiogram with aorto-iliac angiogram for better localization and endovascular intervention.