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Lee S, Hwang D, Yun WS, Huh S, Kim HK. Misdiagnosis of Primary Iliac Aneurysmo-Colonic Fistula as a Submucosal Tumor Leading to Delayed Treatment: A Case Report. Vasc Endovascular Surg 2024:15385744241257597. [PMID: 38820567 DOI: 10.1177/15385744241257597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
An aortoenteric fistula (AEF) is an uncommon cause of gastrointestinal bleeding that requires prompt diagnosis and intervention owing to its high mortality rate. Moreover, iliac aneurysmo-colonic fistula is an exceptionally infrequent presentation. We report a unique case of a 71-year-old male presenting with hematochezia, later diagnosed with a primary fistula between a common iliac artery aneurysm and the sigmoid colon. Initially, the patient was misdiagnosed as having a gastrointestinal stromal tumor, leading to delayed and emergent surgical intervention due to massive bleeding 2 days later. This case is particularly notable for its rarity, misinterpretation of the initial diagnosis, complicated surgical procedures, and development of complications including ischemic myopathy. This case highlights the criticality of accurate diagnosis with a high index of suspicion, significance of consultation with a vascular surgeon for vascular abnormalities, and importance of considering ischemic time in the sequence of surgical treatments to ensure timely and appropriate management.
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Affiliation(s)
- Sangho Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyung-Kee Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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2
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Azzopardi M, Wallace T, Khaled YS. Aortoiliac graft-enteric fistula presenting as gastrointestinal hemorrhage: A report on a complex case management. Clin Case Rep 2023; 11:e7801. [PMID: 37593341 PMCID: PMC10427754 DOI: 10.1002/ccr3.7801] [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] [Received: 10/27/2022] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
Key Clinical Message Iliac artery-enteric fistula is a rare cause of lower GI bleeding and can cause life-threatening consequences. A high degree of clinical suspicion is needed in patients with previous aortic surgery to allow early multidisciplinary intervention. Abstract This case study discusses the staged management of a 78-year-old patient presenting with life-threatening lower gastrointestinal (GI) bleeding secondary to an aortoiliac graft-enteric fistula (GEF) into the sigmoid colon on the background of an adenocarcinoma and diverticular disease. The patient had an aorto bi-iliac synthetic dacron graft repair of an abdominal aortic aneurysm (AAA) some 20 years ago. Here, we present a case of successful endovascular treatment of massive hemorrhage as a bridge to definitive second-stage dacron graft explant and autologous vein reconstruction with a simultaneous anterior resection.
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Affiliation(s)
- Michael Azzopardi
- Department of Academic Surgery, Leeds Institute of Medical ResearchSt James's University HospitalLeedsUK
| | - Tom Wallace
- Department of Vascular Surgery, Leeds Vascular InstituteLeeds General InfirmaryLeedsUK
| | - Yazan S. Khaled
- Department of Academic Surgery, Leeds Institute of Medical ResearchSt James's University HospitalLeedsUK
- School of MedicineUniversity of LeedsLeedsUK
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3
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Lorenzo JF, López Arquillo IM, Rey JV. Primary aortoenteric fistula after intravesical instillation of Bacillus Calmette-Guérin for bladder cancer. Vascular 2023:17085381231174923. [PMID: 37148206 DOI: 10.1177/17085381231174923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Primary aortoenteric fistulas (PAEFs) are a rare entity with high morbidity, and their relationship with Bacillus Instillation of Calmette-Guérin is anecdotal. METHODS/RESULTS We present a 68-year-old male with a primary aortoenteric fistula after instillation of Bacillus Calmette-Guérin (BCG) for a non-muscle-invasive bladder cancer. Diagnosis was made by CT angiography, subsequently confirmed by intraoperative findings and results of anatomopathological studies of aortic wall samples. We performed an in-situ reconstruction with a silver prosthesis impregnated in rifampicin with satisfactory evolution at one year. CONCLUSIONS Primary aortoenteric fistula is an extremely rare complication, and although its relationship with intravesical BCG therapy is anecdotal, it should be considered in patients with gastrointestinal bleeding who have previously undergone this treatment. Its diagnosis requires clinical suspicion, and its treatment should be carried out without delay. Long-term targeted anti-biotherapeutic treatment is a fundamental pillar for its management. Reconstruction with an antibiotic-impregnated silver prosthesis is a valid option in cases of controlled infection.
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Affiliation(s)
| | | | - Jorge Vidal Rey
- Department of Angiology and Vascular Surgery, Hospital Álvaro Cunqueiro, Spain
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4
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Li WD, Wu GY, Song B, Zhao J, Li XQ, Zhou M. Case report: Remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair. Front Cardiovasc Med 2022; 9:975871. [PMID: 36304548 PMCID: PMC9592967 DOI: 10.3389/fcvm.2022.975871] [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: 06/22/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Aorto-duodenal fistula (ADF) is a rare cause of upper gastrointestinal bleeding, but it is associated with high mortality. It usually occurs in patients with prior aortic surgery or who have undergone aortic graft placement. Abdominal aortic aneurysm (AAA) might be a cause of primary ADF, which could develop into sudden shock. Because ADF is difficult to diagnose, surgery to correct it has a poor outcome. We here report the successful treatment of an ADF complicated with infected AAA after endovascular repair of a ruptured aneurysm of the iliac artery.
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5
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Endovascular Treatment of Abdominal Infection-induced Aortoenteric Fistula. Ann Thorac Surg 2022; 114:e275-e277. [PMID: 34998736 DOI: 10.1016/j.athoracsur.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/21/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022]
Abstract
Primary aortoenteric fistulas is a rare clinical entity but with fatal outcome, usually arise from atherosclerotic aneurysm, but induced by abdominal infection is extremely rare. We present a case of 54-year-old man with history of Aortic arch replacement and elephant trunk stent implantation 6 years ago for Stanford type A aortic dissection. He underwent enteroscopy and had gastrointestinal perforation during enteroscopy 11 months ago. Since then he had episodes of syncope and Haemorrhage. Finally, a fistula was found on imaging. Endovascular treatment and digestive tract repair was accomplished. At 13-month follow-up, he did not have hematochezia and fever again.
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6
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Briggs B, Manthey D. Under the Radar: A Case Report of a Missed Aortoenteric Fistula. Clin Pract Cases Emerg Med 2021; 5:312-315. [PMID: 34437036 PMCID: PMC8373188 DOI: 10.5811/cpcem.2021.4.51791] [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: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.
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Affiliation(s)
- Blake Briggs
- University of South Alabama, Department of Emergency Medicine, Mobile, Alabama
| | - David Manthey
- Wake Forest University, Department of Emergency Medicine, Winston-Salem, North Carolina
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Kim BY, Kim KB. Primary Aortoduodenal Fistula Causes Massive Melena: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:132-135. [PMID: 33758109 DOI: 10.4166/kjg.2021.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/03/2022]
Abstract
A primary aortoenteric fistula is defined as the spontaneous development of communication between the gastrointestinal tract and the native aorta. This is unlike a secondary aortoenteric fistula that occurs after surgery, such as a vascular graft. A primary aortoenteric fistula is an extremely rare cause of upper gastrointestinal bleeding. The condition is often overlooked because of its extremely low incidence. This paper reports a case of a 75-year-old man who presented with massive melena. Esophagogastroduodenoscopy revealed an ulcer measuring approximately 1.3 cm with a huge pulsating vessel in the third portion of the duodenum. Later, the diagnosis of primary aortoduodenal fistula was confirmed. The patient died in the preoperative stage due to massive bleeding. The findings of this case suggest that the endoscopists should recognize aortoenteric fistula as a potential cause of gastrointestinal bleeding.
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Affiliation(s)
- Byung Yen Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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8
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Georgeades C, Zarb R, Lake Z, Wood J, Lewis B. Primary Aortoduodenal Fistula: A Case Report and Current Literature Review. Ann Vasc Surg 2021; 74:518.e13-518.e23. [PMID: 33549801 DOI: 10.1016/j.avsg.2020.12.046] [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: 10/30/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Christina Georgeades
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Rakel Zarb
- Department of Plastic Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Zoe Lake
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jacob Wood
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, NC
| | - Brian Lewis
- Department of Vascular Surgery, Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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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: 2.3] [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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10
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Miura S, Kurimoto Y, Ujihira K, Masuda T, Yanase Y, Iba Y, Maruyama R, Yamada A. Emergency Endovascular Aneurysm Repair Coupled with Staged Omentopexy for Primary Aorto-Duodenal Fistula. Ann Vasc Dis 2020; 13:183-186. [PMID: 32595797 PMCID: PMC7315232 DOI: 10.3400/avd.cr.19-00104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A primary aorto-duodenal fistula (ADF), a rare, spontaneous development of a communication between the aorta and duodenum, is a disastrous complication of an abdominal aortic aneurysm. A 73-year-old patient with primary ADF underwent emergent endovascular aneurysm repair (EVAR), followed by staged omentopexy, without removing a stent graft (SG). The patient received long-term treatment with antibiotics, and there has been no evidence of infection during a follow-up period of three years. Emergency EVAR coupled with omentopexy, may be a treatment option for primary ADF, even when it means leaving the SG in a potentially infectious site.
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Affiliation(s)
- Shuhei Miura
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosuke Ujihira
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takahiko Masuda
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yohsuke Yanase
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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Petrunić M, Meštrović T, Halužan D, Perkov D, Golemović M, Golubić – Ćepulić B. Recurrent Aortic Infections Due to Unrecognized Aorto-Enteric Fistula. Ann Vasc Surg 2020; 63:455.e11-455.e15. [DOI: 10.1016/j.avsg.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022]
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12
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Lee SM, Lai YK, Wen WD. Aortoenteric fistula secondary to an Inflammatory Abdominal Aortic Aneurysm. J Radiol Case Rep 2019; 13:8-27. [PMID: 32184927 DOI: 10.3941/jrcr.v13i9.3746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Shuhui Melissa Lee
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Yusheng Keefe Lai
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Wei David Wen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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13
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Lirici MM, Tierno SM, Giudice R, Coscarella C, Graziani MG, Pogany G. Secondary aortoenteric fistula successfully treated with staged endovascular repair and duodenal resection without graft removal. MINIM INVASIV THER 2019; 29:114-119. [PMID: 30848980 DOI: 10.1080/13645706.2019.1581623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Secondary aorto-enteric fistulae (SAEF) are rare life-threatening complications that occur after abdominal aortic graft implant to treat aortic aneurysm or occlusive disease. Conventional treatments such as extra-anatomic bypass grafting with aortic ligation and subsequent graft removal with bowel repair are associated with a 25% to 90% operative mortality rate. In the emergency setting, patients unsuitable for major arterial surgery may benefit from a staged, less invasive approach. We present a case of SAEF treated with endoluminal deployment of a stent graft followed by duodenojejunal resection and anastomosis without further aortic reconstruction and graft removal.
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Affiliation(s)
- Marco Maria Lirici
- Department of General Surgery, San Giovanni Hospital Complex, Rome, Italy
| | | | - Rocco Giudice
- Department of Vascular Surgery, San Giovanni Hospital Complex, Rome, Italy
| | - Carlo Coscarella
- Department of Vascular Surgery, San Giovanni Hospital Complex, Rome, Italy
| | | | - Gabriele Pogany
- Department of Vascular Surgery, San Giovanni Hospital Complex, Rome, Italy
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14
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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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15
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Ishimine T, Tengan T, Yasumoto H, Nakasu A, Mototake H, Miura Y, Kawasaki K, Kato T. Primary aortoduodenal fistula: A case report and review of literature. Int J Surg Case Rep 2018; 50:80-83. [PMID: 30086478 PMCID: PMC6085234 DOI: 10.1016/j.ijscr.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 01/22/2023] Open
Abstract
Primary aortoduodenal fistula (PADF) is extremely rare. A PADF case was treated by in situ aortic reconstruction and omental coverage. An elderly man with hematemesis was diagnosed with PADF. The patient had uneventful recovery and discharged 86 days after surgery.
Background Primary aortoduodenal fistula (PADF) is an abnormal connection between the aorta and the duodenum and is a life-threatening condition. It is a very rare cause of gastrointestinal bleeding, which often leads to delay in its diagnosis. Prompt diagnosis and surgical treatment are crucial to improve the outcome of patients with PADF. Presentation of case An 82-year-old man with a history of untreated abdominal aortic aneurysm (AAA) presented to the emergency department with hematemesis. Computed tomography (CT) revealed an AAA with air within the thrombus wall and disruption of the fat layer between the AAA and duodenum, indicating PADF. Emergent surgery, in situ aortic reconstruction using a Dacron graft, and omental coverage were performed. Although the patient needed another surgery for postoperative chylous ascites, he made good recovery and was discharged 86 days after initial surgery. Discussion In our case, the patient presented with hematemesis and a pulsatile abdominal mass on physical examination and had a history of untreated AAA, which helped in prompt diagnosis of PADF. CT findings suggesting PADF include disappearance of the fat plane between the aneurysm and duodenum, air in the retroperitoneum or within the aortic wall, and contrast enhancement within the duodenum. The recommended surgical approach for PADF consists of aortic reconstruction (in situ aortic reconstruction or extra-anatomical bypass) and duodenal repair. Conclusion Our report affirms that CT and open surgery are effective diagnostic and treatment options, respectively, for PADFs.
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Affiliation(s)
- Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan.
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Hiroshi Yasumoto
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Hidemitsu Mototake
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Yuya Miura
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Kyohei Kawasaki
- Department of Cardiovascular Surgery, Okinawa Prefectural Chubu Hospital, Japan
| | - Takashi Kato
- Department of General Surgery, Okinawa Prefectural Chubu Hospital, Japan
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16
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A Rare Cause of Primary Aortoenteric Fistula: Streptococcus parasanguinis Aortitis. Case Rep Gastrointest Med 2017; 2017:9087308. [PMID: 28255476 PMCID: PMC5306989 DOI: 10.1155/2017/9087308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/10/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022] Open
Abstract
Primary aortoenteric fistula is a rare cause of upper gastrointestinal bleed but can lead to significant mortality if the diagnosis is delayed. Aortitis, characterized by inflammation of the aortic wall, is a rare cause of aortoenteric fistula. We present a case report of a 72-year-old male patient with infectious aortoenteric fistula secondary to Streptococcus parasanguinis, along with a review of the literature. This case demonstrates the importance of early diagnosis and aggressive surgical treatment of aortoenteric fistulae and recognizing infectious aortitis as a potential etiology.
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