Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm

Primary and secondary aorto-digestive fistulas in Behçet's disease: A case report and review of the literature

Behçet's disease (BD) is a multisystem chronic autoimmune inflammatory disorder that involves multiple organs. Arterial involvements in BD are rare. One of severe manifestation is the aortic aneurysm which can lead to a rupture. Aorto-duodenal fistulas (ADFs) are the most frequent aorto-digestive fistulas. In this article we will describe and discuss primary and secondary ADFs which occurred in a same patient.

Aorto-enteric fistulas: a physiopathological approach and computed tomography diagnosis

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.