Primary aorto enteric fistula as a cause of massive upper gastro-intestinal bleed-a very rare case presentation (original) (raw)

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.

Primary aortoduodenal fistula presenting as an upper gastrointestinal bleed

The Journal of Emergency Medicine, 1985

0 Abstract -A case of primary aortoduodenal fistula, which presented as an upper gastrointestinal bleed, is described, including a brief review of the literature. Since 1952, with the advent of homograft replacement, there has been a significant decrease in the number of reported cases of aortoenteric fistulas of the primary type.' 0

Primary aortoduodenal fistula presenting as a rare cause of upper gastrointestinal bleeding

Clinical Case Reports

Primary aortoduodenal fistula (ADF) is a serious life‐threatening condition. Unlike secondary ADF which occurs in patients who had previous aortic prosthetic reconstruction, primary ADF is uncommon. Its diagnosis is often unsuspected until surgery or postmortem. We report a rare case of primary ADF presenting as massive gastrointestinal bleeding.

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.

Aortodigestive Fistula: A Rare Cause of Digestive Bleeding

2021

Backgound: Aorto-digestive fistulas remain a fatal disease entity often occurring after vascular surgeries. Eso-gastro-duodenal endoscopy is essential to explore the upper digestive bleeding. The negativity of morphological examinations should not exclude the diagnosis. Diagnosis has benefited in recent years from developments in cross-sectional imaging: computed tomography (CT) and magnetic resonance imaging (MRI). The severity of bleeding is linked to the vital consequences (mortality close to 50% up to 100% in the absence of treatment), functional (30% amputation), and to the underlying infection itself correlated with the attack of the stent and the anastomosis. Patients: We report three cases of aorto-digestive fistulas treated at The University Hospital Hassan II to show the challenging diagnosis and therapeutic of such rare causes of upper digestive bleeding. Results: three patients were admitted to the emergency endoscopy unit for upper digestive bleeding, 2 of them had a medical history of Behcet Disease and two had past aortic aneurism surgery. The couple's upper endoscopy and CT scan angiography made the diagnosis. Unfortunately, 2 patients died from fatal bleeding. Conclusion: Aortodigestive fistula is an extremely serious complication of aortic aneurisms and a rare cause of gastrointestinal bleeding. This diagnosis should be considered in any patient presenting with digestive bleeding with vascular disease or previous history of vascular stent.

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...

Primary aortoenteric fistula: Case report

European Journal of Internal Medicine, 2013

Prezentãm cazul unei paciente in vârstã de 81 de ani, care a fost internatã în clinicã pentru hematemezã, hematochezie şi dureri la nivelul abdomenului inferior. Examinarea echograficã şi tomografia computerizatã au identificat o fistulã primitivã aortoentericã între un anevrism aortic abdominal şi a doua poråiune a duodenului, ceea ce reprezintã o localizare rarã. Sunt discutate aspecte de patologie, diagnostic şi management chirurgical.

Lower intestinal bleeding due to aorto-enteric fistula

Digestive and Liver Disease, 2003

The case is described of a man who complained of intermittent fever and fatigue. After three digestive endoscopies and computed tomography, a 99m technetium-HM-PAO-labelled white cell scan was usefully employed to establish diagnosis. Anaerobic aortic Graft infection and anaemia due to lower intermittent occult intestinal bleeding were found. The intestinal bleeding was caused by secondary aorto-jejunal fistula. This condition is rare, but should be suspected whenever a patient with aortic prosthesis presents with occult digestive bleeding and unexplained fever.

Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding

Autopsy and Case Reports, 2011

Acute upper gastrointestinal bleeding is a potentially life-threatening emergency, especially in the elderly. This condition accounts for approximately 1% of all emergency room admissions. Among the causes of such bleeding is aortoesophageal fistula, a dreaded but apparently rare condition, first recognized in 1818. The great majority of cases are of primary aortoesophageal fistula, caused by atheromatous aortic aneurysms or, less frequently, by penetrating aortic ulcer. The clinical presentation of aortoesophageal fistula is typically characterized by the so-called Chiari's triad, consisting of thoracic pain followed by herald bleeding, a variable, short symptom-free interval, and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospital mortality rate being 60%. Conservative treatment does not prolong survival, and the in-hospital mortality rate is 40% for patients submitted to conventional surgical treatment. Here, we report the case of a 93-year-old woman who presented to the emergency room with a history of hematemesis. The patient was first submitted to upper gastrointestinal endoscopy, the findings of which were suggestive of aortoesophageal fistula. The diagnosis was confirmed by multidetector computed tomography of the chest. Surgery was indicated. However, on the way to the operating room, the patient presented with massive bleeding and went into cardiac arrest, which resulted in her death.