Primary aortoduodenal fistula. A rare cause of acute gastrointestinal hemorrhage

Critical gastrointestinal bleed due to secondary aortoenteric fistula

Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

Ruptured inflammatory aortic aneurysm with aortoenteric fistula and infected with Streptococcus pneumoniae: a review of the literature

We present a case report of a 65-year-old gentleman who presented with an aortoenteric fistula along with a review of the literature. He was found, in addition, to have an inflammatory infrarenal aortic aneurysm with a posterior rupture. Cultures of the aneurysm sac confirmed a Streptococcus pneumoniae infection. The patient had previously presented with pneumonia. Antibody testing revealed an isolated pneumococcal IgG deficiency. The case demonstrates the diverse pathologies associated with aortic aneurysms and a need to be vigilant and occasionally expect the unusual.

[Secondary aortoduodenal fistulas: report of 7 cases]

PURPOSE

Aortoduodenal fistulas are the most frequent aortoenteric fistulas. They may be primary (occurring after aneurysms of the native aorta) or secondary (occurring after aortic prosthesis). Aortoduodenal fistulas are a rare complication of aortic prostheses. They may be caused by prosthesis infection or due to inadequate prosthesis.

METHODS

We report seven observations that emphasize issues pertaining to either diagnosis or therapy.

RESULTS

The delay of occurrence is variable, with a mean of 3 years as reported in the literature. Clinical picture includes upper digestive tract hemorrhage, sometimes fever, abdominal pain or mass. Though difficult, diagnosis can be achieved through gastric endoscopy or CT-scan. Additional diagnostic procedures are often not useful and should not be numerous. Surgical procedures help guide the diagnosis and constitute the main part of the treatment with suture of the duodenum and vascular prosthesis. According to previous works, our observations including prolonged follow-up of the patients suggest that the best vascular treatment is extra-anatomic axillo-bifemoral bypass, while simple suture and prosthesis replacement lead to poor results.

CONCLUSION

Mortality related to aortodigestive fistulas is high (five out of seven patients in the present study) and requires prevention, including more particularly delicate surgery and antibiotic therapy in case of any episode of infection. Aortoduodenal fistulas must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained fever.

Aneurysm of the proper hepatic artery as a rare source of upper gastrointestinal bleeding

The rare case of the penetration of a partially thrombosed aneurysm into the duodenal bulb causing acute upper gastrointestinal bleeding is described. Besides angiography and CT, ultrasound is the method of choice for early detection. In any case of upper gastrointestinal bleeding of unclear origin the existence of an arteriointestinal fistula should be included in the differential diagnosis.

Primary aortoduodenal fistula presenting as an upper gastrointestinal bleed

A case of primary aortoduodenal fistula, which presented as an upper gastrointestinal bleed, is described, including a brief review of the literature. Since 1952, with the advent of homograft replacement, there has been a significant decrease in the number of reported cases of aortoenteric fistulas of the primary type.