A Rare Cause of Primary Aortoenteric Fistula: Streptococcus parasanguinis Aortitis

Aspergillus Species as a Rare Cause of Primary Mycotic Aneurysm With Aortoenteric Fistula

Aortoenteric fistula (AEF) is an abnormal connection between the aorta and the adjacent gastrointestinal (GI) tract and is often misdiagnosed in clinical practice. We present the case of a 65-year-old male, who presented with upper GI bleeding and melena. The patient underwent upper and lower GI examinations with no conclusive findings. A computed tomography scan of the abdomen was suggestive of an AEF. The patient experienced a sudden episode of hematemesis with hemorrhagic shock in the ward, leading to an emergent surgery for bleeding control and repair of the aortic aneurysm and AEF with straight aortic interposition graft and primary repair of the duodenum along with debridement for whitish mycotic debris. A tissue culture from the aortic aneurysm during surgery revealed Aspergillus species infection. AEF is a life-threatening condition with high morbidity and mortality rates, often making it difficult to diagnose. Early surgical intervention is crucial to prevent a fatal outcome. Although rare, fungal infection should be considered in a primary AEF.

Primary Aortoduodenal Fistula: A Case Report and Current Literature Review

Primary aortoduodenal fistula is a rare, life-threatening pathology that is difficult to diagnose and manage. We present the case of a 64-year-old male with a primary aortoduodenal fistula. Our patient initially underwent an endovascular aneurysm repair at an outside institution before being transferred to our tertiary care center, where he ultimately had definitive management with an extra-anatomic bypass, aortic ligation, duodenal resection with primary anastomosis, and gastrojejunostomy tube placement. His surgical cultures grew Candida albicans, and he was discharged with a 6-week course of intravenous antibiotics with subsequent antibiotic suppression for 1 year. He died 14 months postoperatively from tongue squamous cell carcinoma. We also review the current literature regarding epidemiology, pathology, diagnostics, management, and case reports from 2015 to present. Overall, timely diagnosis and treatment is imperative for reducing mortality from primary aortoduodenal fistula, and although formal consensus is lacking regarding most clinical aspects, an increasing number of case reports has helped describe options for management.

Aortoenteric fistula secondary to an Inflammatory Abdominal Aortic Aneurysm

Primary aortoenteric fistulas are rare, with the annual incidence of such fistulas estimated to be 0.007 per million. The most common predisposing conditions for primary aortoenteric fistulas are atherosclerotic abdominal aortic aneurysms or penetrating atherosclerotic ulcers. We illustrate a rare case of an inflammatory aortic aneurysm causing a primary aortic fistula, with a direct fistulous jet from the aorta to the bowel with resultant catastrophic bleeding. In contrast to atherosclerotic aneurysms, most inflammatory aneurysms are symptomatic and show dense perianeurysmal fibrosis and periaortic wall thickening. A direct jet of contrast extravasation from the aorta into a bowel loop, while rarely seen, remains the most specific sign of a primary aorta-enteric fistula. A comprehensive literature review of the clinical presentation, imaging features, and differential diagnosis of a primary aortoenteric fistula are also discussed.