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Aims. An 84-year-old patient with a history of high blood pressure presented to the emergency room with lower abdominal pain and haematochezia. Methods. Clinical:hemodynamically stable. Biological: WBC 32700/microL, Hb=8.1 g/dL, PLT = 321 000/microL, INR=1.23, CRP = 292 mg/L. CTscan: no contrast extravasation in the digestive tract, infrarenal aortic aneurysm (130 mm cranio-caudal), with parietal thrombus plus a retroaortic abscess with stenosis of the inferior vena cava. Vascular surgery consultation: no surgical indication ->admission to the gastroenterology department. Emergency upper GI endoscopy: adherent clot in the fornix, stasis fluid. 60 cm rectosigmoidoscopy: mucosal lesions suggestive of ischemic colitis. Reevaluation after 12 h: WBC = 26 000/microL, hemoglobin = 7.1 g/dL Results. Re-evaluation of the CT-scan: suspicion of an aorto-duodenal fistula. Second upper GI endoscopy: gastric mucosa, bulb and D2 lined with fresh blood. On withdrawal, an infrapapillary lesion suggestive for an aortoenteric fistula. Duodenoscopesecond look:an erosion with a diameter of 10 mm with a deep punctate hole: most likely aortoenteric fistula. The patient was transferred to cardio-vascular surgery: double-layer duodenorrhaphy and aorto-aortic interposition of a silver Dacron prosthesis were done. Conclusion. The particularity of the case was represented by the rare cause of haemorrhage with difficult diagnosis. The approach and treatment required a multidisciplinary team and a good collaboration. The patient was discharged after 17 days with a good general condition. [ABSTRACT FROM AUTHOR]

Aims. Variceal bleeding is a common and severe cause of hospitalization in cirrhotic patients. We analyzed how the COVID-19 waves modified the outcome of the patients compared to COVID-19 extra-wave intervals. Methods. We retrospectively included all patients hospitalized between March 2020 and December 2021 for variceal bleeding. They were separated in 2 categories: hospitalizations during COVID-19 extrawaves period and the COVID-19 waves. Variables like sex, age, hemoglobin at presentation, endoscopic timing, hemostatic methods, transfusion necessity, duration of hospitalization and mortality were analyzed. Results. Out of 76 patients (2020-2021), 20patients were hospitalized during the COVID-19 waves. The median age did not differ significantly across groups (61 years [IQR: 52-65] vs 58years [IQR: 44-64]), 59 patients being male and 17 being female. The number of admissions for variceal bleeding and gastroscopy requirement and timing were similar regardless of the studied period (p > 0.05). Median hemoglobin admission values were significantly lower in the following subgroups: patients in whom gastroscopy was performed in less than 6 hours or more than 12 hours (p = 0.045) and patients requiring PRBC transfusion (p = 0.018). There were also no differences in duration of hospitalization and mortality between the two studied periods (p>0.05). Conclusions. The number of patients remained relatively constant in both periods. We found no differences in the management and outcomes of patients with variceal bleeding throughout the COVID pandemic. Our results might be influenced by the low number of patients and need confirmation on larger cohorts. [ABSTRACT FROM AUTHOR]