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Yamamoto M, Nomura K, Shibuya T, Omori M, Odakura R, Ito K, Fukushima H, Nomura O, Ishikawa D, Nagahara A. Primary aorto-enteric fistula diagnosed by double-balloon endoscopy. DEN OPEN 2025; 5:e70118. [PMID: 40248441 PMCID: PMC12003205 DOI: 10.1002/deo2.70118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 03/28/2025] [Accepted: 04/06/2025] [Indexed: 04/19/2025]
Abstract
A primary aorto-enteric fistula (PAEF), rarer than a secondary aorto-enteric fistula, is a direct rupture of the bowel by an abdominal aortic aneurysm (AAA). More than 54% of cases were in the duodenum, while jejunum and ileum were affected in only 15% of cases. An 82-year-old woman with hematemesis and hematochezia was admitted to our hospital emergently. Upper and lower endoscopies did not reveal the source of bleeding. We performed an urgent antegrade double-balloon endoscopy, revealing a submucosal tumor-like protuberance with an ulcer in the jejunum. These findings raised suspicion by PAEF. Subsequent computed tomography showed free air near the AAA, confirming PAEF as the hemorrhage source. An abdominal aortic stent graft was implanted, followed by laparotomy. An adhesion between the AAA and small intestinal wall was found. Postoperative recovery was uneventful, with no recurrence observed. This case underscores the importance of considering PAEF as a potential diagnosis in patients with gastrointestinal bleeding and a history of AAA. Endoscopists should be aware of submucosal tumor such as in this case to avoid misdiagnosing PAEF, as diagnosis and intervention are crucial for favorable outcomes.
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Affiliation(s)
- Momoko Yamamoto
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Kei Nomura
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Tomoyoshi Shibuya
- Department of GastroenterologyJuntendo University School of MedicineJapan
- Department of Pathophysiological Research and Therapeutics for Gastrointestinal DiseaseJuntendo University School of MedicineJapan
| | - Masashi Omori
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Rina Odakura
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Kentaro Ito
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Hirofumi Fukushima
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Osamu Nomura
- Department of GastroenterologyJuntendo University School of MedicineJapan
| | - Dai Ishikawa
- Department of GastroenterologyJuntendo University School of MedicineJapan
- Department of Pathophysiological Research and Therapeutics for Gastrointestinal DiseaseJuntendo University School of MedicineJapan
| | - Akihito Nagahara
- Department of GastroenterologyJuntendo University School of MedicineJapan
- Department of Pathophysiological Research and Therapeutics for Gastrointestinal DiseaseJuntendo University School of MedicineJapan
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2
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Kobayashi M, Fukaguchi K, Koyama H, Taguchi A, Sekine I, Yamagami H. Aortoesophageal Fistula-Induced Rare Life-Threatening Hematemesis in the Emergency Department: A Case Series and Literature Review. Cureus 2025; 17:e80980. [PMID: 40260326 PMCID: PMC12010216 DOI: 10.7759/cureus.80980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2025] [Indexed: 04/23/2025] Open
Abstract
Background and objective Aortoesophageal fistula (AEF) is a rare but life-threatening condition. It is often challenging to promptly diagnose AEF given the diversity of chief complaints and clinical presentations at the time of initial treatment. In some cases, upper gastrointestinal endoscopy is performed, and emergency surgery is delayed, or the disease is judged to be mild and rapidly worsens, ultimately resulting in the patient's death. In this study, we aimed to investigate the clinical characteristics of AEF in patients at the time of emergency department visits, which were only partially described in previous studies. Methods We retrospectively reviewed the medical records of patients diagnosed with AEF from May 2013 to May 2023 at a tertiary medical center in Japan. Results Six patients were diagnosed with AEF during the study period. The median age of the patients was 75.5 years, and four were females. All six patients had the chief complaint of hematemesis; three (50%) had bright red hematemesis and four (67%) had a relatively small amount of hematemesis. Two (33%) experienced syncope. Three (50%) were clinically diagnosed with shock upon arrival at the hospital. Four (67%) had a history of post-aortic surgery, aortic aneurysm, or esophageal cancer. Conclusions AEF should be considered in patients with hematemesis, especially those with distinctive underlying diseases, shock, or syncope, even if hematemesis only involves a small amount of blood or is bright red.
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Affiliation(s)
- Masahiro Kobayashi
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Kiyomitsu Fukaguchi
- Division of Critical Care, Shonan Kamakura General Hospital, Kanagawa, JPN
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Hiroshi Koyama
- Division of Critical Care, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Azusa Taguchi
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Ichiro Sekine
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
| | - Hiroshi Yamagami
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN
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3
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Masuda H, Yamamoto Y, Ae R. Recurrent Hematochezia Due to a Rectal Fistula Caused by a Left Internal Iliac Artery Aneurysm. Cureus 2025; 17:e79483. [PMID: 40135012 PMCID: PMC11933728 DOI: 10.7759/cureus.79483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2025] [Indexed: 03/27/2025] Open
Abstract
Arterio-enteric fistulas (AEFs) are a rare cause of gastrointestinal bleeding involving direct communication between an artery and the intestinal tract. The duodenum is the most common fistula site for AEFs, but none of the rectal cases are known. We present the case of an elderly man with hematochezia due to a rectal fistula caused by a left internal iliac artery aneurysm, which was detected on contrast-enhanced computed tomography (CT), showing typical fistula formation and ectopic gas images. This case highlights the importance of considering the occurrence of rare but potentially fatal AEFs in elderly patients with hematochezia and that the timely performance of contrast-enhanced CT is critical for an accurate diagnosis.
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Affiliation(s)
- Hiroya Masuda
- Department of General Medicine, Sunagawa City Medical Center, Sunagawa, JPN
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, JPN
| | - Yu Yamamoto
- Division of General Medicine, Jichi Medical University, Shimotsuke, JPN
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, JPN
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4
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Mulita F, Leivaditis V, Verras GI, Pitros C, Dimopoulos P, Katsakiori PF, Dafnomili D, Tchabashvili L, Tasios K, Kehagias D, Antzoulas A, Papadoulas S, Koletsis E. Secondary aortoenteric fistula: a narrative review of the view of the surgeon. Arch Med Sci Atheroscler Dis 2024; 9:e66-e71. [PMID: 38846053 PMCID: PMC11155463 DOI: 10.5114/amsad/186358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 06/09/2024] Open
Abstract
Aortoenteric fistula (AEF) is defined as the abnormal communication between the aorta and the gastrointestinal tract. AEFs are divided into primary and secondary usually after abdominal aortic aneurysm (AAA) recovery and are a rare but quite dangerous cause of gastrointestinal bleeding that the general surgeon may face during his/her career. Secondary AEF was first described in 1953 to a 44-year-old woman 3 months after an AAA operation. This review presents the role of the surgeon in the management of secondary aortoenteric fistulas. AEFs are a rare but fatal gastrointestinal bleeding cause that the general surgeon may be asked to manage. Diagnosis requires the combination of strong clinical suspicion and the presence of a history of AAA surgery. Although a vascular surgery case, general surgeons play a role in choosing the technique of restoring the intestinal tract, which seems to be significantly related to subsequent morbidity and mortality.
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Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | | | - Christos Pitros
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Platon Dimopoulos
- Department of Interventional Radiology, General University Hospital of Patras, Patras, Greece
| | | | - Danai Dafnomili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Spyros Papadoulas
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece
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5
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Freitas BD, Dionisio A, Ferreira B, Azevedo S, Araújo I. Aortoenteric Fistula: A Differential Diagnosis of Anemia. Cureus 2023; 15:e42952. [PMID: 37667694 PMCID: PMC10475294 DOI: 10.7759/cureus.42952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
Aortoenteric fistulas (AEFs) are a rare and deadly cause of gastrointestinal bleeding that can be easily overlooked, leading to massive bleeding. Secondary AEFs are more common than primary AEFs. An example of a secondary cause of anemia is postoperative hemorrhage due to a surgically placed aortic graft or after endovascular aneurysm repair. This report aims to increase the awareness of AEF as a differential diagnosis when anemia is detected. The clinical report presents a case of anemia in a 79-year-old man due to a secondary AEF, which occurred in a patient who had undergone abdominal aortic aneurysm surgery 10 years before. Surgical repair is considered the gold standard for AEF treatment; however, in this case, the patient was managed with medical therapy and discharged after two months.
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Affiliation(s)
- Bruno D Freitas
- Department of Internal Medicine, Hospital de São Francisco Xavier, Lisbon, PRT
| | - Antony Dionisio
- Department of Internal Medicine, Hospital de São Francisco Xavier, Lisbon, PRT
| | - Beatriz Ferreira
- Department of Internal Medicine, Hospital de São Francisco Xavier, Lisbon, PRT
| | - Samuel Azevedo
- Department of Internal Medicine, Hospital de São Francisco Xavier, Lisbon, PRT
| | - Inês Araújo
- Heart Failure Clinic, Department of Internal Medicine, Hospital de São Francisco Xavier, Lisbon, PRT
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6
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Jaber F, Alsakarneh S, Sanders K, Ibrahim A, Ghoz H, Clarkston W, McMahon C. It Is Not Always Diverticular Bleeding: Fatal Subtle Primary Aorto-Duodenal Fistula Associated With Abdominal Aortic Aneurysm. Cureus 2023; 15:e34461. [PMID: 36874685 PMCID: PMC9980874 DOI: 10.7759/cureus.34461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
Primary aorto-duodenal fistula (PADF) is a connection between the aorta and duodenum without prior aortic surgery. We present a case of an 80-year-old female who presented with hematochezia. She was vitally stable but later developed a large episode of hematemesis followed by cardiac arrest. A computed tomography angiogram (CTA) chest scan showed an abdominal aortic aneurysm (AAA) with no leakage or rupture. Esophagogastroduodenoscopy (EGD) demonstrated blood in the stomach and duodenum, but no source was identified. Tagged RBC scan showed massive hemorrhage in the stomach and proximal small bowel. Further review of the CT images identified a subtle PADF. The patient underwent endovascular aneurysm repair but died shortly after. Physicians should maintain a high awareness of PADF, particularly in elderly patients with obscure gastrointestinal bleeding with or without known AAA. Herald bleeding in the setting of an aortic aneurysm should raise suspicion for PADF even in the absence of extravasation on CTA.
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Affiliation(s)
- Fouad Jaber
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Saqr Alsakarneh
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Kimberly Sanders
- Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, USA
| | - Ali Ibrahim
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Hassan Ghoz
- Gastroenterology, University of Missouri-Kansas City, Kansas City, USA
| | - Wendell Clarkston
- Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, USA
| | - Charles McMahon
- Gastroenterology and Hepatology, Mid-America Gastro-Intestinal Consultants, Kansas City, USA
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7
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Secondary Aorto-Colonic Fistula: A Case Report and Literature Review of a Rare Complication after EVAR. Case Rep Surg 2022; 2022:8412460. [DOI: 10.1155/2022/8412460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Aorto-enteric fistula (AEF) is a rare but fatal condition. The incidence of the overall AEF was approximately 0.36–2%, but the incidence of the aorto-colonic fistula was scarcely reported. A history of abdominal pain, fever, or gastrointestinal bleeding (GIB) in a patient with a history of aortic intervention should be highly suspected of this condition. This report describes a patient with lower GIB after an endovascular aneurysm repair (EVAR) for a symptomatic abdominal aortic aneurysm (AAA). Case Presentation: A 65-year-old man with a history of EVAR for symptomatic AAA presented with a massive lower GIB for two weeks. He also had a history of left lower quadrant pain and low-grade fever. Diverticular disease was suspected, and medical treatment was administered. After the initial conservative treatment, a colonoscopy was performed. The findings showed a fistula that exposed an aortic stent graft at the left-sided colon. An aorto-colonic fistula was diagnosed. After administering intravenous (IV) antibiotics, a staged axillo-bifemoral bypass graft with aortic stent graft explantation was performed. The patient recovered well and was discharged home after a month of hospitalization and IV antibiotics. Conclusion: In a patient with a history of aortic intervention, any abdominal pain, unknown fever, or even GIB should be suspected of complications of aortic intervention. Highly suspicious of this rare condition is the key to an early diagnosis and prompt treatment.
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8
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Busch M, Stahl K, Fuge J, Schrimpf C, RIttgerodt N, Greer M, Mederacke YS, Haverich A, Wedemeyer H, Heidrich B, Schneider A, Lenzen H, Mederacke I. Out of sight for the endoscopist? Gastrointestinal bleeding after aortic repair. Scand J Gastroenterol 2022; 57:1112-1119. [PMID: 35527697 DOI: 10.1080/00365521.2022.2062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Secondary Aortoenteric Fistulas (sAEF) are difficult to diagnose and usually result in fatal gastrointestinal (GI) bleeding following aortic repair. Outcomes are largely dependent on a timely diagnosis, but AEFs remain challenging to identify endoscopically and are usually diagnosed on computed tomography (CT) scans. The aim of our study was optimize diagnosis of AEF by identifying patients developing GI bleeding after aortic repair, investigate their clinical course and identify factors specific to different bleeding sources. METHODS A retrospective, single-center study capturing all patients developing upper or lower GI bleeding after aortic surgery between January 2009 and March 2020 was performed. Electronic health records were screened for diagnostic codes of the relevant procedures. Bleeding was classified into three groups: AEF with demonstrable fistula, ischemic - macroscopic ulceration plus histological confirmation or imaging and "other" due to other recognized conventional cause, such as peptic ulcer disease. RESULTS 47 GI bleeding episodes in 39 patients were identified. Of these, 10 episodes (21%) were caused by AEF, 16 (34%) by ischemic ulceration and 21 (45%) due to other causes. Patients with AEF exhibited more frequent hemodynamic instability requiring vasopressors and had higher mortality, while ischemic ulcerations were associated with more recent operation or hypotensive episode. CONCLUSIONS GI bleeding complications are uncommon following aortic surgery. AEF and ischemic ulceration are however frequent bleeding causes in this cohort. In patients presenting with fulminant bleeding, primary CT-scanning should be considered.
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Affiliation(s)
- Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Claudia Schrimpf
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nina RIttgerodt
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Young-Seon Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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9
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Gadela T, Paravathaneni M, Manney D, Bandla H. A Rare Cause of Gastrointestinal Bleeding: Aorto-Enteric Fistula. Cureus 2022; 14:e27023. [PMID: 35989755 PMCID: PMC9386321 DOI: 10.7759/cureus.27023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
Aorto-enteric fistula is defined as an abnormal connection between the gastrointestinal system and the aorta. The patients who develop this condition usually have a grim prognosis and the cases are universally fatal unless intervened with an endovascular repair or open surgical repair. Given the rarity and the relative unfamiliarity of this condition, an understanding of the presentation, pathogenesis, and management is vital to prevent catastrophic complications.
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10
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Vacca G, De Berardinis C, Cappabianca S, Vanzulli A. A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it. BJR Case Rep 2022; 8:20210143. [PMID: 35136648 PMCID: PMC8803215 DOI: 10.1259/bjrcr.20210143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Although gastrointestinal hemorrhage from aorto-enteric fistulae (AEF) secondary to previous aortic grafts are well known, a primary aorto-enteric fistula (PAEF) without aortic aneurysm is an extremely rare event resulting in poor prognosis and outcome. PAEF is a rare cause of gastro-intestinal (GI) bleeding that radiologists should consider because often its presence is not easily guessed by clinical features. It is difficult to detect at CT examination therefore PAEF might be not diagnosed until a laparotomy. We report a case of a 74-year-old Italian male who presented to our Emergency Department (ED) with brightly red rectal bleeding that occurred from some hours and a pre-syncopal episode. There was no history of analgesic abuse, peptic ulceration, alcohol excess, and weight loss. Standard resuscitation was commenced with the hope that common sources of bleeding such as peptic ulcers or varices would eventually be discovered by endoscopy and treated definitely. An upper GI endoscopy showed brightly red blood in the stomach and in the first portions of duodenum, but no source of active bleeding was found. Diagnosis of PAEF was made by CT and after confirmed during surgical intervention. Both the duodenum and the aorta were successfully repaired by direct suture and synthetic graft replacement, respectively. Diagnosis of primary aortic duodenal fistula (ADF) has been very difficult in this case especially because our patient did not have abdominal aortic aneurism (AAA) history confirmed by CT examination. Radiologist should remember that upper GI bleeding could however be determined by primary ADF also if atherosclerotic damage is severe as in this case. A technically good and complete exam is mandatory to achieve this rare and complex diagnosis. Particularly, an ultra-tardive acquisition phase (5 min after contrast administration) could be helpful to suspect the presence of PADF: the appearance of contrast into the duodenal lumen is an evocative sign useful to increase clinical and radiological suspicious of ADF. Gl bleeding should be assumed to be caused from a PAEF unless another source can be identified without delay. A timely and accurate diagnosis of primary AEF may be challenging due to insidious episodes of GI bleeding, which are frequently under diagnosed until the occurrence of massive hemorrhage.
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Affiliation(s)
- Giovanna Vacca
- Department of University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | | | | | - Angelo Vanzulli
- Department of Radiology, University “La Statale” of Milan, Milan, Italy
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11
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Berner-Hansen V, Olsen AA, Brandstrup B. Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature. World J Gastrointest Endosc 2021; 13:189-197. [PMID: 34163566 PMCID: PMC8209543 DOI: 10.4253/wjge.v13.i6.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
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Affiliation(s)
- Victoria Berner-Hansen
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
| | - August A Olsen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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12
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Chen C, Kim JW, Shin JH, Kwon Y, Kim J, Lee IJ. Management of life-threatening aortoesophageal fistula: experiences learned from eight patients. Acta Radiol 2021; 62:447-452. [PMID: 32551870 DOI: 10.1177/0284185120933228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding. PURPOSE To report our experiences in the management of life-threatening AEF. MATERIAL AND METHODS A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes. RESULTS Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years. CONCLUSION Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
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13
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Luo J, Tang W, Wang M, Xiao Y, Tan M, Jiang C. Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding. BMC Gastroenterol 2021; 21:49. [PMID: 33530944 PMCID: PMC7856786 DOI: 10.1186/s12876-021-01629-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Aortoenteric fistula (AEF) is a rare cause of gastrointestinal bleeding and is often misdiagnosed in clinical practice. Herein, a case series of AEFs are presented and the clinical characteristics, diagnosis, and management strategies are summarized. METHODS A retrospective analysis was performed on consecutive hospitalized patients with a final diagnosis of AEF at Beijing Friendship Hospital, Capital Medical University, between January 1, 2007 and March 31, 2020. The clinical data including diagnostic and management procedures as well as outcomes were collected and summarized. RESULTS A total of nine patients were included in this study, five with primary AEF and four with secondary AEF. Eight of the patients were male, and the median age was 63 years. The fistulas were located in both the small intestine and the colon. All patients presented with gastrointestinal bleeding and pain, followed by weight loss, anorexia, and fever. A typical abdominal triad was found in only two cases. Seven patients experienced complications with preoperative abdominal infections and sepsis, and multiple organ failure occurred in four of these patients. All patients were assessed by computed tomography and five underwent abdominal and/or iliac aorta angiography. Two of these patients showed contrast agent leakage from the abdominal aorta into the intestine. Two cases were diagnosed with AEF by endoscopy before the operation. Eight patients received surgery and six patients survived. CONCLUSIONS AEF is a rare cause of gastrointestinal bleeding that is associated with high mortality. Gastrointestinal bleeding and pain are the most common presentations. Timely diagnosis and multidisciplinary management are crucial to achieve a positive outcome.
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Affiliation(s)
- Jia Luo
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Wen Tang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Mengran Wang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Yao Xiao
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Manhong Tan
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Chunyan Jiang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China.
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14
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Kunioka S, Kitahara H, Ohira S, Tada Y, Akasaka N, Kamiya H. Surgical Management of Aortoenteric Erosion Due to Pulsatile Stress After Aneurysm Repair: A Case Report. Ann Vasc Dis 2020; 13:355-357. [PMID: 33384747 PMCID: PMC7751083 DOI: 10.3400/avd.cr.20-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Secondary aortoenteric fistula or erosion (SAEFE), an abnormal connection between the aorta and gastrointestinal tract, is a rare but critical complication after abdominal aortic aneurysm repair. Most SAEFEs occur between the aorta or proximal graft anastomosis and the duodenum, and occurrence between the iliac graft and small intestine is rare. Standard SAEFE management involves graft removal and extra-anatomical bypass. However, this is extremely invasive and has a high mortality rate. We encountered a rare case of SAEFE with no sign of infection, which was successfully treated by ligating the iliac graft to reduce mechanical pulsatile stress and bleeding following the retroperitoneal approach.
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Affiliation(s)
- Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University
| | | | - Seima Ohira
- Department of Cardiac Surgery, Asahikawa Medical University
| | - Yuki Tada
- Department of Cardiovascular Surgery, Steel Memorial Muroran Hospital
| | - Nobuyuki Akasaka
- Department of Cardiovascular Surgery, Steel Memorial Muroran Hospital
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15
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Nagrani Chellaram S, Martínez Chamorro E, Borruel Nacenta S, Ibáñez Sanz L, Alcalá-Galiano A. Aortoenteric fistulas: Spectrum of MDCT findings. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Aortoenteric fistulas: spectrum of MDCT findings. RADIOLOGIA 2020; 62:280-291. [PMID: 32245628 DOI: 10.1016/j.rx.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/01/2020] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography.
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17
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Li M, Li Y, Zhu Q, Xiong G, Chen S. Primary Aortogastric Fistula Caused by Ulcerated Gastric Carcinoma: A Rare Cause of Sudden Death. J Emerg Med 2020; 58:e169-e171. [PMID: 32213294 DOI: 10.1016/j.jemermed.2020.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/18/2019] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Minfang Li
- Department of Internal Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China; The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yaqing Li
- Department of Internal Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
| | - Qinghua Zhu
- Department of Internal Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
| | - Guang Xiong
- Department of Internal Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
| | - Sheng Chen
- Department of Internal Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, Guangdong Province, China
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18
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Kayashima A, Mori H, Okuzawa A, Kubosawa Y, Hirai Y, Kinoshita S, Nakazato Y, Fujimoto A, Kikuchi M. An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm. Case Rep Gastroenterol 2019; 13:214-218. [PMID: 31123449 PMCID: PMC6514484 DOI: 10.1159/000500067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/01/2019] [Indexed: 01/21/2023] Open
Abstract
An aortoesophageal fistula, an abnormal anatomical communication between the aorta and the esophagus, is a rare cause of upper gastrointestinal bleeding. The mortality rate of patients with this condition is very high. A 77-year-old man, who had undergone endovascular aortic repair for a ruptured abdominal aortic aneurysm, developed melena. An upper gastrointestinal endoscopy was performed. This detected an esophageal ulcer, which had the potential to develop into an aortoesophageal fistula. Therefore, thoracic endovascular aortic repair was performed on the following day. Thereafter, the course was uneventful. We encountered a rare case of an esophageal ulcer associated with a thoracoabdominal aortic aneurysm before it developed into an aortoesophageal fistula.
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Affiliation(s)
| | - Hideki Mori
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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19
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Affiliation(s)
- Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS 390, Houston, TX 77030, USA.
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20
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Lin TC, Tsai CL, Chang YT, Hu SY. Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report. BMC Cardiovasc Disord 2018; 18:113. [PMID: 29879911 PMCID: PMC5992757 DOI: 10.1186/s12872-018-0852-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022] Open
Abstract
Background Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate. Case presentation We report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta. Conclusions A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.
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Affiliation(s)
- Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Chung-Lin Tsai
- Divison of Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yao-Tien Chang
- Department of Emergency Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. .,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.
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21
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Yang Y, Hu D, Peng D. Primary aortoesophageal fistula: A fatal outcome. Am J Emerg Med 2018; 36:343.e1-343.e3. [DOI: 10.1016/j.ajem.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
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22
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Liao E, Simons M, Tse LW, Roche-Nagle G. Toothpick-induced aortoenteric fistula presenting as sepsis. BMJ Case Rep 2017; 2017:bcr-2016-218338. [PMID: 28611134 PMCID: PMC5534662 DOI: 10.1136/bcr-2016-218338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aortoenteric fistulas (AEF) are a rare but life-threatening cause of gastrointestinal (GI) bleeding. We present the case of a primary AEF caused by ingestion of a toothpick by a 47-year-old male. This is the 10th known case in the literature in which a foreign body was found to be the cause of a communication between the aorta and the GI tract. Most foreign objects have been sewing needles; this is the first known case of a toothpick penetration. The patient presented to our institution with polymicrobial sepsis and bilateral pulmonary septic emboli. The patient was successfully treated but required multiple interventions and a prolonged intensive care unit admission.
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Affiliation(s)
- Elizabeth Liao
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Martin Simons
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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23
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“In situ” endografting in the treatment of arterial and graft infections. J Vasc Surg 2017; 65:1824-1829. [DOI: 10.1016/j.jvs.2016.12.134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
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24
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Ho S, Liu B, Loya R, Koury I. Primary Aortoenteric Fistula: A Rare Case of a Massive Gastrointestinal Bleed. Cureus 2016; 8:e766. [PMID: 27725922 PMCID: PMC5045327 DOI: 10.7759/cureus.766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aortoenteric fistulas (AEFs) are deadly, abnormal connections between the aorta and gastrointestinal (GI) tract. While secondary aortoenteric fistulas (SAEFs) are more common and arise after aortic reconstruction, primary aortoenteric fistulas (PAEFs) are generally caused by abdominal aortic aneurysms (AAAs). PAEFs may present with self-limited GI bleeds called “herald bleeds,” and the fistula often goes undiagnosed until patients undergo laparotomy for a massive GI bleed. We describe a case of a PAEF in a 79-year-old man with known AAA. Due to variable clinical presentations and the rarity of the condition, many patients with PAEF die before an accurate diagnosis is made. In interpreting computed tomography (CT) scans of AEFs, the role of the radiologist is critical in the management of PAEF patients.
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Affiliation(s)
- Simon Ho
- College of Medicine, University of Central Florida
| | - Bo Liu
- Diagnostic Radiology, Florida Hospital-Orlando
| | - Raul Loya
- Diagnostic Radiology, Florida Hospital-Orlando
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25
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Deijen CL, Smulders YM, Coveliers HME, Wisselink W, Rauwerda JA, Hoksbergen AWJ. The Importance of Early Diagnosis and Treatment of Patients with Aortoenteric Fistulas Presenting with Herald Bleeds. Ann Vasc Surg 2016; 36:28-34. [PMID: 27423720 DOI: 10.1016/j.avsg.2016.03.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/24/2016] [Accepted: 03/20/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Massive bleeding in patients with aortoenteric fistula (AEF) may be preceded by minor, intermittent gastrointestinal (GI) blood loss, termed the "herald bleed." The aims of this retrospective study were to: (i) analyze the interval between the herald bleed and onset of major GI hemorrhage and/or diagnosis of AEF and (ii) to evaluate the diagnostic roles of endoscopy and computed tomography imaging. METHODS Analysis of all patients diagnosed with AEF or iliac-enteric fistulas between 1994 and 2013 in a single institution. RESULTS In 31 of a total of 34 fistula cases, GI bleeding was the presenting symptom. Of these, 17 of 31 presented with herald bleed while 14 of 31 presented with massive GI bleeding. In patients with a herald bleed, median time from first bleeding to diagnosis was 14 (2-137) days. In 5/17 patients, herald bleeding preceded major hemorrhage with a median of 6 (4-92) days before a diagnosis of AEF was made or intervention could be initiated. CT angiography (CTA) showed abnormalities associated with a fistula in 27 (79%) cases, of which in 12 (35%) cases a fistula was actually identified. Esophagogastroduodenoscopy (EGD) demonstrated a fistula in 8 (25%) patients, while 50% of EGDs were completely normal. CONCLUSIONS Any patient with history of aortic surgery and GI bleeding should be considered to have an AEF until proven otherwise. The sensitivity of CTA for detecting AEF is substantially greater than that of EGD. The time interval between herald bleed and subsequent massive hemorrhage associated with AEF is unpredictable but may be as short as 4 days.
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Affiliation(s)
- Charlotte L Deijen
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans M E Coveliers
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan A Rauwerda
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
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26
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Contemporary Management of Secondary Aortoduodenal Fistula. Ann Vasc Surg 2015; 29:1614-8. [DOI: 10.1016/j.avsg.2015.06.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/23/2015] [Accepted: 06/28/2015] [Indexed: 11/20/2022]
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27
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Kazuhiro K, Suzuki S, Shimamura Y. Fistula formation between perianeurysmal hematoma and sigmoid colon: rare cause of lower gastrointestinal bleeding. Dig Endosc 2015; 27:631-2. [PMID: 25940858 DOI: 10.1111/den.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/21/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Kosugi Kazuhiro
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Shoko Suzuki
- Department of Gastroenterology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuto Shimamura
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
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28
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Varetto G, Gibello L, Trevisan A, Castagno C, Garneri P, Rispoli P. Primary Aortoenteric Fistula of a Saccular Aneurysm: Case Study and Literature Review. Korean Circ J 2015; 45:337-9. [PMID: 26240589 PMCID: PMC4521113 DOI: 10.4070/kcj.2015.45.4.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/05/2014] [Accepted: 06/25/2015] [Indexed: 02/05/2023] Open
Abstract
Primary aortoenteric fistula is a direct communication between the aorta and intestinal lumen and it represents a rare but potentially lethal complication of an abdominal aortic aneurysm. However, it may occur less frequently in a naive non-aneurysmatic aorta. Diagnosis is often difficult and delayed in most cases, unless there is a high level of clinical awareness. Urgent surgery is still the recommended treatment. We describe the case of primary aortoenteric fistula of a saccular aneurysm. A 55-year-old woman was referred to our center with hematemesis, melena, and severe anemia who was dignosed previously with unknown saccular abdominal aneurysm.
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Affiliation(s)
- Gianfranco Varetto
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Lorenzo Gibello
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandra Trevisan
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Claudio Castagno
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo Garneri
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Pietro Rispoli
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
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29
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Lee W, Jung CM, Cho EH, Ryu DR, Choi D, Kim J. Primary aortoenteric fistula to the sigmoid colon in association with intra-abdominal abscess. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 63:239-43. [PMID: 24755749 DOI: 10.4166/kjg.2014.63.4.239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.
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Affiliation(s)
- Wonho Lee
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Chul Min Jung
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Eun-Hee Cho
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Dong Ryeol Ryu
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Daehee Choi
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Jaihwan Kim
- Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Korea
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30
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Chen ZJ, Freeman ML. Management of upper gastrointestinal bleeding emergencies: evidence-based medicine and practical considerations. World J Emerg Med 2014; 2:5-12. [PMID: 25214975 DOI: 10.5847/wjem.j.1920-8642.2011.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 01/26/2011] [Indexed: 01/06/2023] Open
Abstract
Acute upper gastrointestinal (GI) bleeding remains one of the most common encounters in emergency medicine. The increased use of non-steroid anti-inflammatory drugs by the general population and the increased prescription of anti-platelet agents and anti-coagulants after cardiovascular interventions and for prevention of cerebral vascular accidents may have aggravated the situation. Significant progress has been made in the past decade or so in the non-surgical management of acute upper GI bleeding emergencies. This article will review the current standard treatment of the most common upper GI bleeding emergencies in adults as supported by evidence-based medicine with practical considerations from the authors' own practice experience.
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Affiliation(s)
- Zongyu John Chen
- Minnesota Gastroenterology PA, Minneapolis, MN 55414 (Chen ZJ); Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN 55455 (Freeman ML), USA
| | - Martin L Freeman
- Minnesota Gastroenterology PA, Minneapolis, MN 55414 (Chen ZJ); Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN 55455 (Freeman ML), USA
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31
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Gunji S, Okabe H, Obama K, Sakai Y. Aortoenteric fistula at the site of esophagojejunostomy after laparoscopic total gastrectomy: report of a case. Surg Today 2014; 44:2162-6. [DOI: 10.1007/s00595-014-0834-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
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32
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Hsu WF, Lin CC, Chang KM, Lee TH. Primary aortoesophageal fistula: a rare but fatal cause of upper gastrointestinal bleeding. J Dig Dis 2013; 14:676-8. [PMID: 23672477 DOI: 10.1111/1751-2980.12070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Wei Fan Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, China
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Santos VPD, Razuk Filho A, Castelli Junior V, Caffaro RA. Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer. Int Braz J Urol 2013; 39:747-50; discussion 751. [DOI: 10.1590/s1677-5538.ibju.2013.05.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 05/25/2013] [Indexed: 11/22/2022] Open
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34
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Kim JS, Han JH, Kang MH, Choi YR, Chae HB, Park SM, Youn SJ. [A case of primary aortoenteric fistula mimicking ulcer bleeding]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 61:343-6. [PMID: 23877216 DOI: 10.4166/kjg.2013.61.6.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Primary aortoenteric fistula (PAEF) is a rare disease with a high mortality rate due to massive hemorrhaging and diagnostic difficulties. Although hemorrhagic regions can be identified by endoscopy, it is difficult to diagnose PAEF by this method. If PAEF is suspected, endoscopic procedure should be terminated and abdominal CT should be performed. Overlooking the herald bleeding of PAEF can lead to massive bleeding and death. An 85-year-old previously healthy male presented with a complaint of melena. Gastrointestinal endoscopy identified a hemorrhagic site in the third portion of the duodenum and endoscopic hemostasis was performed. However, during the procedure, it became apparent that the hemorrhage was probably not the result of a simple duodenal ulceration and abdominal CT was performed immediately. An aortic aneurysm connected to the duodenum was identified, confirming the diagnosis of PAEF. However, the patient died of massive hemorrhaging before an operation could be performed.
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Affiliation(s)
- Jae Su Kim
- Department of Internal Medicine, Yuseong Sun Hospital, Daejeon, Korea
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Sarac M, Marjanovic I, Bezmarevic M, Zoranovic U, Petrovic S, Mihajlovic M. An aortoduodenal fistula as a complication of immunoglobulin G4-related disease. World J Gastroenterol 2012; 18:6164-7. [PMID: 23155348 PMCID: PMC3496896 DOI: 10.3748/wjg.v18.i42.6164] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/02/2012] [Accepted: 07/09/2012] [Indexed: 02/06/2023] Open
Abstract
Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair.
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Aorto-enteric fistulas: a physiopathological approach and computed tomography diagnosis. Diagn Interv Imaging 2012; 93:840-51. [PMID: 23092721 DOI: 10.1016/j.diii.2012.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infection of an abdominal aortic prosthesis with an enteroprosthetic fistula is a very serious, life-threatening complication, leading sometimes to severe functional consequences, the most serious being amputation. Since the symptoms, if there are any, are often rather non-specific, diagnosis is frequently difficult and has always to be based on a whole series of justifications. Early diagnosis is essential and this fistula should be the first possibility considered in a patient with an abdominal aortic prosthesis who is presenting rectorrhagia or melaena (even if only to a slight degree), sepsis and/or abdominal pain. Although rare, the clinical existence of hypertrophic osteoarthropathy may assist diagnosis. A CT scan is the examination of choice, the criteria providing evidence of a fistula being the presence of gaseous images in a periprosthetic fluid collection, thickening and/or retraction of the intestinal walls in contact, the existence of a false aneurysm, and finally, very rarely, extravasation of contrast agent into the intestinal lumen. The differential diagnoses that may mimic a fistula need to be well known, and can include retroperitoneal fibrosis, an infectious aneurysm, inflammatory or infectious aortitis, and above all, a 'simple' prosthesis infection without fistulisation.
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Genovés-Gascó B, Torres-Blanco Á, Plaza-Martínez Á, Olmos-Sánchez D, Gómez-Palonés F, Ortiz-Monzón E. Primary aortoduodenal fistula in a patient with pararenal abdominal aortic aneurysm. Ann Vasc Surg 2012; 26:730.e1-5. [PMID: 22503432 DOI: 10.1016/j.avsg.2011.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/13/2011] [Accepted: 11/04/2011] [Indexed: 11/15/2022]
Abstract
Primary aortoenteric fistula is a rare and extremely serious condition. In most cases, it is caused by an abdominal aortic aneurysm presenting with symptoms of gastrointestinal bleeding. Diagnosis is difficult owing to its rarity and the fact that diagnostic tests are not definitive in many cases. Surgery is performed urgently in most cases and is associated with high mortality. We report a case of a 65-year-old man presenting with symptoms of abdominal pain and massive rectal hemorrhage. Computed tomography revealed a pararenal abdominal aortic aneurysm and suspected aortoenteric fistula. The patient underwent an emergency surgery, confirming the suspected diagnosis. The surgery performed was the traditionally recommended extra-anatomical bypass with aortic ligation and repair of the intestinal defect. We describe the clinical condition and provide an up-to-date overview of diagnosis and treatment by reviewing the literature. We believe the therapeutic decision should be personalized by assessing the anatomy of the aneurysm, the patient's clinical status, the degree of local contamination, and the surgeon's experience with each of the techniques.
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Affiliation(s)
- Beatriz Genovés-Gascó
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario Dr. Peset, Valencia, España.
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Singh S, Ladabaum U, Hovsepian DM, Triadafilopoulos G. Cancer-associated aorto-enteric fistula. Dig Dis Sci 2012; 57:625-9. [PMID: 22021052 DOI: 10.1007/s10620-011-1945-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 10/08/2011] [Indexed: 12/09/2022]
Affiliation(s)
- Sundeep Singh
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Always Building M211, Stanford, CA 94305, USA.
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Duvnjak S, Andersen PE. Life-threatening Arterioenteric Fistula Bleeding Treated by Embolization. Cardiovasc Intervent Radiol 2012; 35:1535-8. [DOI: 10.1007/s00270-012-0354-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 01/06/2012] [Indexed: 12/15/2022]
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Kakkos SK, Papadoulas S, Tsolakis IA. Endovascular management of arterioenteric fistulas: a systemic review and meta-analysis of the literature. J Endovasc Ther 2011; 18:66-77. [PMID: 21314352 DOI: 10.1583/10-3229.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To present a systemic review and meta-analysis investigating the outcomes of endovascular management of arterioenteric fistula (AEF). METHODS Literature review on AEF management with endovascular surgery using MEDLINE search, including two cases managed by the authors. RESULTS Fifty-nine patients (50 men; mean age 68 years, range 23-90) were identified. AEF was successfully managed in 55 (93%) patients and 30-day mortality was 8.5% (5/59). During follow-up, 10 (19%) patients developed recurrent bleeding, which occurred more often in AEFs due to cancer. The freedom from recurrence rate at 12 and 24 months was 71.5%. Seventeen (32%) patients developed sepsis, which was managed conservatively in 8 (7 successful). Freedom from sepsis at 12 and 24 months was 64%, while the freedom from combined recurrence and sepsis at 12 and 24 months was 59%. Patients who did not have intestinal repair had a higher rate of combined recurrence and sepsis compared to patients who did; the freedom from combined recurrence and sepsis at 12 months was 52% for patients not having intestinal repair versus 100% in patients who did (p = 0.022). Total AEF-related mortality rates at 12 and 24 months were 15% and 19%, respectively, significantly worse when AEF recurred (p = 0.001). Overall survival rates at 12 and 24 months were 68% and 52%; prognosis was worse in patients with perioperative sepsis, large bowel fistulization, tube graft placement, no intestinal repair, and recurrent AEF. CONCLUSION Endovascular management of AEF can achieve satisfactory short and midterm results, better than those historically reported for open surgery, despite the high rate of recurrent bleeding and sepsis. Further investigation of the role played by intestinal repair is warranted.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Rio, Patras Greece.
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Huang JH, Chen JS, Chu SH, Chiu KM. Recurrent cervical carcinoma presenting as a primary aortoduodenal fistula. Ann Vasc Surg 2010; 24:1133.e5-7. [PMID: 20800434 DOI: 10.1016/j.avsg.2009.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/08/2009] [Indexed: 11/26/2022]
Abstract
Aortoduodenal fistula is a rare cause of gastrointestinal (GI) bleeding, and carries high morbidity and mortality even in modern practice. Cervical carcinoma is a major health threat among adult women, and its recurrence is not uncommon. We herein present a case of primary aortoduodenal fistula because of recurrent cervical carcinoma. Our case demonstrated that diagnosis of primary aortoenteric fistula requires a high index of suspicion and a combination of diagnostic modalities to establish the diagnosis. Prompt diagnosis and rapid treatment are critical in reducing mortality and morbidity. Although rare, metastatic carcinoma can lead to aortoenteric fistula.
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Affiliation(s)
- Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, Taipei, Taiwan
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Fuks D, Humbert-Claude C, Deguines JB, Sabbagh C, Browet F, Hajji H, Blampain S, Reix B, Chatelain D, Reix T, Régimbeau JM. [Conservative treatment of an aortoduodenal fistula after paraaortic lymphadenectomy in hepatobiliary malignancy surgery with aortic endoprosthesis]. JOURNAL DES MALADIES VASCULAIRES 2010; 35:179-184. [PMID: 20097496 DOI: 10.1016/j.jmv.2009.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 12/07/2009] [Indexed: 05/28/2023]
Abstract
Lower gastrointestinal bleeding from a primary aortoduodenal fistula is unusual and usually fatal. Postoperative aortoduodenal fistula after biliary surgery is a very rare complication. We report hence a 69-year-old female patient who underwent a main bile duct resection with extended paraaortic lymphadenectomy for a cholangiocarcinoma. Acute melena with hemoglobin drop occurred on postoperative day 24. Initial CT-scan showed an aortic pseudoaneurysm with aortoduodenal fistula. An aortic endoprosthesis with endoscopic drainage of periaortic collections allowed successful treatment.
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Affiliation(s)
- D Fuks
- Service de chirurgie digestive, fédération médicochirurgicale de pathologies digestives, CHU Nord-Amiens, place Victor-Pauchet, Amiens cedex 1, France
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Ahn M, Shin BS, Park MH. Aortoesophageal fistula secondary to placement of an esophageal stent: emergent treatment with cyanoacrylate and endovascular stent graft. Ann Vasc Surg 2010; 24:555.e1-5. [PMID: 20371165 DOI: 10.1016/j.avsg.2009.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 10/31/2009] [Accepted: 12/20/2009] [Indexed: 11/15/2022]
Abstract
We report on N-butyl 2-cyanoacrylate embolization and subsequent endovascular stent graft placement for the treatment of an aortoesophageal fistula secondary to placement of an esophageal stent. A 53-year-old man with lung cancer was admitted with massive hematemesis due to the formation of an aortoesophageal fistula 20 days after esophageal stent placement. Injection of N-butyl 2-cyanoacrylate into the aortoesophageal fistula was performed as emergent treatment for this hemodynamically unstable condition, and an endovascular stent graft was subsequently placed via the right femoral artery. The patient was well without hematemesis until he died of pneumonia 45 days later. Cyanoacrylate embolization and subsequent endovascular stent graft placement for the treatment of massive hemorrhage caused by an aortoesophageal fistula is a prompt, effective method and can be an alternative to surgical repair.
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Affiliation(s)
- Moonsang Ahn
- Department of Surgery, Chungnam National University Hospital, Taejon 301-721, South Korea
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Unexpectedly large aortoesophageal fistula inconsistent with CT imaging due to the thrombus working as the tamponade. J Cardiol 2009; 54:466-9. [DOI: 10.1016/j.jjcc.2009.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 02/04/2009] [Accepted: 02/11/2009] [Indexed: 11/22/2022]
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Jayarajan S, Napolitano LM, Rectenwald JE, Upchurch GR. Primary aortoenteric fistula and endovascular repair. Vasc Endovascular Surg 2009; 43:592-6. [PMID: 19640906 DOI: 10.1177/1538574409335275] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary aortoenteric fistulae are difficult conditions to diagnose and manage. A 35-year-old male developed massive upper gastrointestinal hemorrhage due to a primary aortoduodenal fistula. Previous radiation therapy and retroperitoneal lymph node dissection for germ cell cancer with resultant dense retroperitoneal fibrosis made open aortic repair impossible. Endovascular balloon occlusion of the aorta and stent graft repair of the primary aortoduodenal fistula was performed. At 1-year follow-up, there is no clinical or radiographic evidence of stent-graft infection. Endovascular techniques and repair are important approaches to consider during the management of complicated primary aortoenteric fistulae when open surgical repair is not feasible.
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Affiliation(s)
- Senthil Jayarajan
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Zhou JC, Xu QP, Shen LG, Pan KH, Mou YP. Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago. J Zhejiang Univ Sci B 2009; 10:400-3. [PMID: 19434768 DOI: 10.1631/jzus.b0820231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum, but a prolonged shock led to the patient's death. In summary, early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.
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Affiliation(s)
- Jian-cang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
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Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option? Eur J Vasc Endovasc Surg 2009; 37:407-12. [DOI: 10.1016/j.ejvs.2008.11.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/25/2008] [Indexed: 02/06/2023]
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