Lower intestinal bleeding due to aorto-enteric fistula (original) (raw)
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Aorto-enteric fistula: a dilemma for the endoscopist as a rare cause of gastro-intestinal bleeding
Acta chirurgica Belgica
A 78-year-old man with a history of aorta-femoral graft operation was admitted to the hospital with symptoms of syncope, melena and haematemesis. He reported several episodes of melena during the previous year for which he underwent repeated gastro-intestinal endoscopic examinations, which were unable to show the site of the gastro-intestinal bleeding. The third upper gastro-intestinal endoscopic examination disclosed a yellowish ulcerative lesion with irregular borders in the third part of the duodenum, which was considered to be a fistula, between the aorta and the duodenum. The patient underwent an explorative operation that revealed an intact aortic graft, firmly adherent to the duodenal wall, and the duodenum that was eroded in the third portion. The duodenum was transected and a duodenoduodenostomy was performed. Although re-bleeding did not occur, the patient died of sepsis eight days after the operation. Aorto-enteric fistulae can be missed due to the common practice of limi...
F1000Research, 2021
Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protru...
An Insidious Gastrointestinal Bleeding from Secondary Aortoduodenal Fistula Leading to Septic Shock
Case Reports in Gastrointestinal Medicine, 2019
Insidious gastrointestinal bleeding from a secondary aortic fistula poses a significant diagnostic challenge. Failure to recognize it early on can lead to devastating outcomes. We describe a case of insidious gastrointestinal bleeding from a secondary aortic fistula in an elderly woman who presented with recurrent admissions for melanotic stools and eventually developed septic shock. Esophagogastroduodenoscopy did not reveal any obvious source of bleeding. The patient eventually had push endoscopy that revealed infected graft and a secondary aortoduodenal fistula. One should proceed with push enteroscopy in occult bleeding if the patient has a history of abdominal aortic aneurysm repair.
International Surgery Journal
Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.
Secondary Aortoenteric Fistula After Abdominal Aortic Graft Implementation in Our Own Material
Advances in Clinical and Experimental Medicine, 2016
nal bleeding, often preceded by mild, self-limiting "herald bleeding". Other symptoms include: abdominal pain, back pain, hemorrhagic shock, septic shock, or a combination of hemorrhage and sepsis [5, 8-10]. A variety of diagnostic procedures are involved in the diagnosis of SAEF, e.g., contrast enhanced CT and gastroduodenoscopy [11, 12]. However, diagnosis can be made using an ultrasound, and sometimes an initial diagnosis is based only on a physical examination and the history of aortic graft placement. Patients with SAEF A secondary aortoenteric fistula (SAEF) occurs after abdominal aortic graft implementation due to an aneurysm or atherosclerosis in 0.4-2.4% of cases [1-3]. Several factors are involved in the pathogenesis of SAEF: graft infection, bowel erosion caused by anastomotic pseudoaneurysm, contact of the pulsatile aortic graft with the duodenum leading to erosion of the graft through the bowel wall, and possible injury to the bowel during graft implementation [4-7]. The most common clinical presentation of SAEF is severe gastrointesti
P0057 Aortoduodenal Fistula: A Rare Cause of Gastrointestinal Bleeding
European Journal of Internal Medicine, 2009
Background: Aortoenteric fistula(AEF) is a rare and deadly vascular complication usually secondary to aortic aneurysmal graft repair causing massive bleeding. Recurrent AEF, years after the initial repair, is an even rarer occurrence. Case presentation: We present a case of a 58 year old male with history of abdominal aortic aneurysm, who was brought to the emergency department (ED) after being found unresponsive with a visual approximation by EMT of 500ml of bright red blood per rectum. Unlike many previous case reports our patient's recurrent fistula occurred years after second repair in 2012. Conclusions: Although rare, abdominal aortic aneurysm (AAA) repair can form enteric fistula causing massive bleeding which is a medical emergency. Patient can present with hemodynamic instability. Urgent vascular imaging and repair is necessary for the management.
Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
International Journal of Surgery Case Reports, 2015
INTRODUCTION: Primary aorto-enteric fistula (AEF) is an uncommon life-threating condition. Only 4% of them involve the jejunum or ileum and its mortality ranges from 33 to 85%. PRESENTATION OF CASE: A 54-year-old female was admitted to the Emergency Department with syncope and hematemesis. The esophagogastroduodenoscopy found a pulsatile vessel in the second portion of the duodenum. A computed tomography scan showed an AEF with an infrarenal aortic aneurysm and iliac artery thrombosis. During surgery, an infrarenal aortic aneurysm complicated with an aorto-jejunal fistula was found. An axilo-bifemoral bypass, open repair of the aneurysm and segmental small bowel resection with primary suture of the jejunal defect were performed. DISCUSSION: Depending on previous aortic grafting, AEF can be classified as primary or secondary. Primary AEF is usually caused by an untreated abdominal aortic aneurysm, commonly presenting an infectious etiology. The main clinical sign is a "herald" hemorrhage. The EGD is considered as the first step in diagnosing AEF. The treatment of choice for AEF is emergent surgery. Use of broad-spectrum antibiotics is mandatory in the postoperative period to avoid fistula recurrence. CONCLUSION: AEF is a rare entity with a high mortality. High clinical suspicion is essential to make a correct diagnosis, which is crucial for the prognosis of these patients, such is the case of our patient. If hemodynamic stability is achieved, it allows to employ surgical strategies in which extra-abdominal bypass is performed before fistula is treated.