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Rezaei H, Ghasemi F, Johari HG, Gholami MA. A complicated case of primary aortojejunal fistula: A case report. Int J Surg Case Rep 2024; 120:109842. [PMID: 38851068 PMCID: PMC11220515 DOI: 10.1016/j.ijscr.2024.109842] [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: 03/17/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Aortoenteric fistulas are rare and life-threatening pathology characterized by an abnormal connection between the aorta and the gastrointestinal tract. CASE PRESENTATION The patient is a 61-year-old male who initially presented with hypogastric pain, hematemesis, and melena. Computed tomography angiography (CTA) revealed an abdominal aorta aneurysm but not a fistula. Imaging modalities were inconclusive in the diagnosis. The patient became unstable hemodynamically and was transferred to the operation room. The definitive diagnosis of aortoenteric fistula was confirmed during surgical exploration. Urgent surgery was performed; however, the patient experienced a cascade of complications, including rebleeding, intestinal leakage, and hemodynamic instability due to aortic bleeding. Despite rigorous interventions, the patient expired due to multiple organ failure 53 days after the first repair surgery. CLINICAL DISCUSSION There is no definite imaging method due to the lack of guidelines, and the absence of exact findings has led to intraoperative diagnosis in up to 50 % of cases. This is one of the modalities of choice to examine suspected aortoenteric fistulas. Many authors prefer Computed tomography (CT) with intravenous contrast for suspected AEF despite its limitations in clarity. Others recommend CT angiography as the preferred modality. It is worth noting that, as reported in a comprehensive retrospective review, the mortality rate is approximately 46 % within 60 days after AEF repair surgery. CONCLUSION This report adds to the limited data about primary aortojejunal fistulas, an extremely rare type of aortoenteric fistulas which has been reported in only a few cases. Understanding the importance of promptly suspecting, diagnosing, and intervening is crucial, emphasizing the importance of sharing such cases for medical guidance and better patient outcomes.
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Affiliation(s)
- Hooman Rezaei
- Department of Surgery, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnia Ghasemi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hamed Ghoddusi Johari
- Thoracic and Vascular Surgery Research center, Shiraz University of Medical Sciences, Shiraz, Iran
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Patel RM, Bye MA, Batista PM. Temporizing stent graft for aortoenteric fistula with massive gastrointestinal hemorrhage. Vascular 2024; 32:296-299. [PMID: 36384347 DOI: 10.1177/17085381221140950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES We present a case of a 59-year-old male with an actively bleeding aortoenteric fistula (AEF) that was temporized using an endovascular stent prior to staged open reconstruction. METHODS Verbal informed consent was given by the patient's family for publication of this case report. The patient presented with pulseless electrical activity secondary to hemorrhagic shock due to a massive gastrointestinal bleed. His past surgical history included an aortobifemoral bypass (ABFB) that subsequently underwent extra-anatomic reconstruction with right axillofemoral artery bypass for right femoral infected pseudoaneurysm. Two months prior to presentation, he underwent a second revision with in-situ reconstruction for left limb graft infection. CTA now demonstrated actively bleeding AEF. He was emergently treated with endovascular stenting. Once stabilized, a two-stage revision with extra-anatomic bypass and aortic stump closure for management of his AEF was performed. RESULT The patient was adequately stabilized using endovascular techniques followed by two-stage revision but unfortunately expired secondary to septic shock 20 days postoperatively. CONCLUSION This case highlights the utility of endovascular stent graft to successfully obtain hemodynamic stability and optimization prior to open repair of AEFs.
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Affiliation(s)
- Raj M Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Matthew A Bye
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Philip M Batista
- Deparement of Vascular and Endovascular Surgery, Cooper University Hospital, Division of Vascular Surgery, Camden, NJ, USA
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3
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Weise LB, Crisostomo PR, Bechara CF, Soult MC. Iliac artery-enteric fistulas following failed pancreatic transplant. J Vasc Surg Cases Innov Tech 2024; 10:101427. [PMID: 38375348 PMCID: PMC10875587 DOI: 10.1016/j.jvscit.2024.101427] [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: 10/14/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction.
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Affiliation(s)
- Lorela B. Weise
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, IL
| | - Paul R. Crisostomo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, IL
| | - Carlos F. Bechara
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, IL
| | - Michael C. Soult
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, IL
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Akamatsu D, Serizawa F, Umetsu M, Suzuki S, Goto H, Unno M, Kamei T. Revascularization and Digestive Tract Repair in Secondary Aortoenteric Fistula Using a Single-Center in Situ Revascularization Strategy. Ann Vasc Surg 2024; 101:148-156. [PMID: 38159719 DOI: 10.1016/j.avsg.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 10/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Information regarding optimal revascularization and digestive tract repair in secondary aortoenteric fistula (sAEF) remains unclear. Thus, reporting treatment outcomes and presenting comprehensive patient details through a structured treatment approach are necessary to establish a treatment strategy for this rare, complex, and fatal condition. METHODS We performed a single-center retrospective review of consecutive sAEF managed based on our in situ revascularization and intestinal repair strategy. The primary endpoint of this study was all-cause mortality, and secondary endpoints were the incidence of in-hospital complications and midterm reinfections. RESULTS Between 2007 and 2020, 16 patients with sAEF, including 13 men (81%), underwent in situ revascularization and digestive tract repair. The median follow-up duration for all participants was 36 (interquartile range, 6-62) months. Among the participants, 81% (n = 13), 13% (n = 2), and 6% (n = 1) underwent aortic reconstruction with rifampin-soaked grafts, unsoaked Dacron grafts, and femoral veins, respectively. The duodenum was the most commonly involved site in enteric pathology (88%; n = 14), and 57% (n = 8) of duodenal breaks were repaired by a simple closure. Duodenum's second part-jejunum anastomosis was performed in 43% of patients (n = 6), and 19% of the patients (n = 3) died perioperatively. In-hospital complications occurred in 88% patients (n = 14), and the most frequent complication was gastrointestinal. Finally, 81% patients (n = 13) were discharged home. Oral antibiotics were administered for a median duration of 5.7 months postoperatively; subsequently, the participants were followed up carefully. Reinfection was detected in 6% of the patients (n = 1) who underwent reoperation without any complications. The 1-year and 3-year overall survival rates of participants were 75% (n = 12) and 75% (n = 9), respectively, and no sAEF-related deaths occurred, except perioperative death. CONCLUSIONS Surgical intervention with contemporary management based on our vascular strategy and digestive tract procedure may be a durable treatment for sAEF.
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Affiliation(s)
| | - Fukashi Serizawa
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Michihisa Umetsu
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Shunya Suzuki
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | | | - Michiaki Unno
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
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Pagano KM, Fokin AA, Parra M, Puente I. Stop exsanguination by inflation: management of aorta-esophageal fistula bleeding. J Surg Case Rep 2024; 2024:rjae120. [PMID: 38463737 PMCID: PMC10924743 DOI: 10.1093/jscr/rjae120] [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: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Aortoesophageal fistula is rare and typically presents itself to the emergency department as Chiari's Triad of mid-thoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval. However, fatal bleeding may be the first and last presentation of an aortoesophageal fistula. When a patient experiences massive hematemesis without witnesses, EMS may assume that bleed is of a traumatic mechanism. We present a case of a 59-year-old male with no previous medical history who was transported to a trauma center unconscious and with massive bleeding of unknown origin. Computed tomography revealed a thoracic aortic aneurysm and an aortoesophageal fistula. Bleeding was not controlled and the patient expired. Trauma bay personnel should follow an algorithm which includes a prompt tamponade of the bleed using a Sengstaken-Blakemore tube or esophageal balloon paralleled by massive transfusion and obtaining an early computed tomography scan to manage patients with massive gastroesophageal bleeding until appropriate surgical interventions can be initiated.
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Affiliation(s)
- Kristina M Pagano
- Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St AHC2, Miami, FL 33199, United States
| | - Alexander A Fokin
- Department of Trauma and Acute Care Surgery, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, United States
| | - Michael Parra
- Department of Trauma and Acute Care Surgery, Broward County Health Care System, 1800 NW 49th Street, STE. 110, Fort Lauderdale, FL 33309, United States
| | - Ivan Puente
- Department of Trauma and Acute Care Surgery, Broward County Health Care System, 1800 NW 49th Street, STE. 110, Fort Lauderdale, FL 33309, United States
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Sieber S, Busch A, Sargut M, Knappich C, Bohmann B, Karlas A, Friess H, Eckstein HH, Novotny A. A Modern Series of Secondary Aortoenteric Fistula - A 19-Year Experience. Vasc Endovascular Surg 2024; 58:185-192. [PMID: 37608725 DOI: 10.1177/15385744231198363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Secondary aortoenteric fistula is a rare and life-threatening condition. Clear evidence on the ideal therapeutic approach is largely missing. This study aims to analyze symptoms, etiology, risk factors, and outcomes based on procedural details. PATIENTS AND METHODS All patients with secondary aortoenteric fistula admitted between 2003 and 2021 were included. Patient characteristics, surgical procedure details, and postoperative outcomes were analyzed. Outcomes were stratified and compared according to the urgency of operation and the procedure performed. Descriptive statistics were used. The primary endpoint was in-hospital mortality. RESULTS A total of twentytwo patients (68% male, median age 70 years) were identified. Main symptoms were gastrointestinal bleeding, pain, and fever. From the twentytwo patients ten patients required emergency surgery and ten urgent surgery. Emergency patients were older on average (74 vs 63 years, P = .015) and had a higher risk of postoperative respiratory complications (80% vs 10%, P = .005). Primary open surgery with direct replacement of the aorta or an extra-anatomic bypass with an additional direct suture or resection of the involved bowel was performed in sixteen patients. In four patients underwent endovascular bridging treatment with the definitive approach as a second step. Other two patients died without operation (1x refusal; 1x palliative cancer history). In-hospital mortality was 27%, respectively. Compared to patients undergoing urgent surgery, those treated emergently showed significantly higher in-hospital (50% vs 0%, P = .0033) mortalities. CONCLUSION Despite rapid diagnosis and treatment, secondary aortoenteric fistula remains a life-threatening condition with 27% in-hospital mortality, significantly increased upon emergency presentation.
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Affiliation(s)
- Sabine Sieber
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
- Division of Vascular and Endovascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technical University of Dresden, Dresden, Germany
| | - Mine Sargut
- Department of Surgery, Technical University of Munich Hospital Rechts der Isar Medical Clinic and Polyclinic II, Munich, Germany
| | - Christoph Knappich
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Angelos Karlas
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich Hospital Rechts der Isar Medical Clinic and Polyclinic II, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), Technical University of Munich Hospital Rechts der Isar, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Technical University of Munich Hospital Rechts der Isar Medical Clinic and Polyclinic II, Munich, Germany
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Narayanan A, Hanna J, Okamura-Kho A, Tesar J, Lim E, Peden S, Dean A, Taumoepeau L, Katib N, Lyons O, Khashram M. Management of secondary aorto-enteric fistulae: a multi-centre study. ANZ J Surg 2023; 93:2363-2369. [PMID: 37012584 DOI: 10.1111/ans.18441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/12/2023] [Accepted: 03/19/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Secondary aorto-enteric fistulae (SAEF) are a rare, complex and life-threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long-term management. METHODS This was a retrospective, observational, multi-institutional cohort study. Patients who had been treated for SAEF between 2003 and 2020 were identified using a standardized database. Baseline characteristics, presenting features, microbiological, operative, and post-operative variables were recorded. The primary outcomes were short and mid-term mortality. Descriptive statistics, binomial regression, Kaplan-Meier and Cox age-adjusted survival analyses were performed. RESULTS Across 5 tertiary centres, a total of 47 patients treated for SAEF were included, 7 were female and the median (range) age at presentation was 74 years (48-93). In this cohort, 24 (51%) patients were treated with initially with OAR, 15 (32%) with EVAR-first and 8 (17%) non-operatively. The 30-day and 1-year mortality for all cases that underwent intervention was 21% and 46% respectively. Age-adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR-first group compared to the OAR-first group, HR 0.99 (95% CI 0.94-1.03, P = 0.61). CONCLUSION In this study there was no difference in all-cause mortality in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad-spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.
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Affiliation(s)
- Anantha Narayanan
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Vascular Surgery, Wellington Hospital, Wellington, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Joseph Hanna
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Amy Okamura-Kho
- Department of Vascular Surgery, Auckland Hospital, Auckland, New Zealand
| | - Joshua Tesar
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Eric Lim
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Sam Peden
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Anastasia Dean
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Auckland Hospital, Auckland, New Zealand
| | - Lupe Taumoepeau
- Department of Vascular Surgery, Wellington Hospital, Wellington, New Zealand
| | - Nedal Katib
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Oliver Lyons
- Department of Vascular Surgery, Christchurch Hospital, Christchurch, New Zealand
- Department of Surgery, University of Otago, Otago, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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El Beyrouti H, Omar M, Calimanescu CT, Treede H, Halloum N. Paracolic Gutter Routing: A Novel Retroperitoneal Extra-Anatomical Repair for Infected Aorto-Iliac Axis. J Clin Med 2023; 12:5765. [PMID: 37685832 PMCID: PMC10488997 DOI: 10.3390/jcm12175765] [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: 07/24/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE We describe and analyze outcomes of a novel extra-anatomical paracolic gutter routing technique for surgical repair of aorto-iliac infections. METHODS A double-center, observational, cohort study of all consecutive patients with aorto-iliac infections treated using extra-anatomical paracolic gutter technique. Between May 2015 and December 2022, six patients with aorto-iliac infections were treated with the paracolic gutter routing technique. Cases were identified retrospectively in an institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. RESULTS Aorto-bifemoral vascular reconstructions were performed using this technique in six patients. During mean follow-up of 52 ± 44 months, there was one case of graft thrombosis (17%) with subsequent successful thrombectomy. Primary and secondary graft patency rates were 83% and 100%, respectively. There was one mortality (17%) due to candida sepsis. All graft prostheses were patent at last follow-up. CONCLUSIONS The paracolic gutter technique is a useful technique in patients with extensive aorto-iliac infections, arteriovenous and iliac-ureteric fistulas, or at a high risk of vascular graft infection and is associated with favorable reinfection and patency rates.
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Affiliation(s)
- Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Mohamed Omar
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | | | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
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Tabbara D, Frankel A, Thomson I. Primary and subsequent secondary aorto-enteric fistulae in the setting of chronic Q fever. J Surg Case Rep 2023; 2023:rjac579. [PMID: 36727123 PMCID: PMC9885518 DOI: 10.1093/jscr/rjac579] [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: 10/17/2022] [Accepted: 11/26/2022] [Indexed: 01/31/2023] Open
Abstract
We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.
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Affiliation(s)
- Dana Tabbara
- Correspondence address. Department of Surgical Specialties, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia. E-mail:
| | - Adam Frankel
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Iain Thomson
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Ćeranić D, Nikolić S, Lučev J, Slanič A, Bujas T, Ocepek A, Skok P. Fatal bleeding due to an aorto-esophageal fistula: A case report and literature review. World J Clin Cases 2022; 10:11493-11499. [PMID: 36387793 PMCID: PMC9649541 DOI: 10.12998/wjcc.v10.i31.11493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/27/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aorto-esophageal fistula is an extremely rare cause of acute upper gastrointestinal bleeding (UGIB).
CASE SUMMARY We present a case of an 80-year-old woman with esophageal cancer who was admitted to our department with hemorrhagic shock due to UGIB. During the diagnostic procedure, emergency computed tomography angiography was performed and confirmed aorto-esophageal fistula. Interventional radiologists inserted a stent graft into the aorta, successfully closing the fistula. Unfortunately, the patient later died of heart failure following irreversible hemorrhagic shock. Autopsy confirmed the aorto-esophageal fistula, which formed 1 cm below the distal edge of the stent previously inserted into the esophagus for a malignant stricture.
CONCLUSION There are very rare causes of UGIB. Although clinical decisions are made during the diagnostic workup of these patients, we must be aware of the limitations of various therapeutic options, even the most contemporary.
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Affiliation(s)
- Davorin Ćeranić
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Sara Nikolić
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Jernej Lučev
- Department of Radiology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Aleš Slanič
- Department of Radiology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Tatjana Bujas
- Department of Pathology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Andreja Ocepek
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Pavel Skok
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
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11
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Bacopanos E, Jansen S, Hockley J. Aortoduodenal Fistula from Duodenal Stenting for Malignant Gastric Obstruction. EJVES Vasc Forum 2022; 57:1-4. [PMID: 36249716 PMCID: PMC9563612 DOI: 10.1016/j.ejvsvf.2022.08.002] [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: 03/21/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Aortoduodenal fistula (ADF) is a rare cause of upper gastrointestinal (GI) bleeding and is usually fatal without intervention. A high index of suspicion is required to identify and successfully manage this condition. Report Three cases of ADF following duodenal stent insertion for gastric outflow obstruction secondary to metastatic adenocarcinoma are presented. All presented with upper GI bleeding and underwent emergency percutaneous endovascular aortic stent graft repair (EVAR), with temporary aortic balloon occlusion in one case. All were successful in achieving haemostasis. The first case, although initially complicated by acute stent thrombosis of the right iliac limb, was discharged to a rehabilitation facility and survived for two years. The second patient died two days after the procedure from sepsis related complications. The third was discharged home six days post-procedure with a three month follow up. Conclusion A high suspicion for ADF in patients with previous duodenal stents is required for prompt diagnosis and management. EVAR may increase short to midterm life expectancy. Aortoduodenal fistula following duodenal stent for malignant gastric obstruction Cases underwent percutaneous endovascular stent graft repair and achieved haemostasis In cases of ADF secondary to duodenal stenting, tube endografting may prolong life.
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12
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Oikonomou K, Pfister K, Kasprzak PM, Schierling W, Betz T, Sachsamanis G. Treatment of Secondary Aortoenteric Fistulas Following AORTIC Aneurysm Repair in a Tertiary Reference Center. J Clin Med 2022; 11:jcm11154427. [PMID: 35956044 PMCID: PMC9369578 DOI: 10.3390/jcm11154427] [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: 06/29/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between January 2005 and December 2018 was performed. Analyzed parameters included patients’ demographics, clinical presentation, diagnostic work-up, perioperative data and repair durability during follow-up. Results: Twenty-three patients with aortoenteric fistulas were treated in the target period. The fistulous connection was located in 21 cases (91.3%) in the duodenum and in two cases (8.7%) in the small intestine. Average time between the initial procedure and detection of the aortoenteric fistula was 69.4 ± 72.5 months. The most common presenting symptom was gastrointestinal bleeding (n = 12, 52.2%), followed by symptoms suggestive of chronic infection (n = 11, 47.8%). Open surgical repair was performed in 19 patients (bridging in 3 patients), and endovascular repair was carried out in two cases and one patient underwent a hybrid operation. One patient underwent abscess drainage due to significant comorbidities. Mean follow-up was 35.1 ± 35.5 months. In-hospital mortality and overall mortality were 43.5% (10/23) and 65.2% (15/23), respectively. Patients presenting with bleeding had a significantly higher perioperative mortality rate in comparison to patients presenting with chronic infection (66.7% (8/12) and 18.2% (2/11), respectively, p = 0.019). Patients who underwent stent-graft implantation for control of acute life-threatening bleeding showed significantly better perioperative survival in comparison to patients that were acutely treated with an open procedure (66.6%, (4/6) and 0% (0/6), respectively, p = 0.014). Perioperative mortality was also higher for ASA IV patients (71.4%, 5/7), when compared to ASA III Patients (31.2%, 5/16), although this did not reach statistical significance (p = 0.074). Conclusion: Treatment of secondary aortoenteric fistulas is associated with a high perioperative mortality rate. Patients who survive the perioperative period following open surgical repair in the absence of hemorrhagic shock show acceptable midterm results during follow-up. Stent-graft implantation for bleeding control in patients presenting with life-threatening bleeding seems to be associated with lower perioperative mortality rates.
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Affiliation(s)
- Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-69-6301-4136
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
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13
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Ge Y, Tuerdi A, Yang X, Tang J, Li Q. Salvaged, Staged, and Safer Management of Aortoesophageal Fistula and Mediastinitis After Removing a Pork Bone: A Case Report. Front Surg 2022; 9:916006. [PMID: 35756482 PMCID: PMC9213657 DOI: 10.3389/fsurg.2022.916006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Aortoesophageal fistula (AEF) caused by esophageal foreign body (EFB) ingestion is a life-threatening condition with a very low survival rate. However, the optimal management strategy remains undetermined. Here, we describe our successful management of a patient with AEF and mediastinitis. A 36-year-old man developed persistent chest and back pain and vomited fresh blood three days after removal of a pork bone in the esophagus under endoscopy in a local hospital. Computed tomography (CT) confirmed bilateral pulmonary infections, mediastinitis, and fistula of the aortic arch. After a multidiscipline discussion, a comprehensive staged strategy was made including salvaged thoracic endovascular aortic repair (TEVAR) to control fatal bleeding, adequate mediastinal debridement, drainage with cervical incision, and video-assisted thoracoscopic surgery, as well as jejunostomy to prevent nasal or gastrostomy reflux from aggravating the mediastinal infection. Furthermore, systematic personalized nutrition support and antibiotics were provided. The patient recovered well and has survived for 50 months until now. Careful assessment should be made with CT to ascertain the risk of AEF before and after the removal of EFB. A salvaged staged strategy of TEVAR with adequate mediastinal debridement and drainage in a less invasive approach may be a safer alternative for AEF patients with infections caused by EFB.
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Affiliation(s)
- Yan Ge
- Department of Rheumatology and Immunology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ayinuer Tuerdi
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Correspondence: Ayinuer Tuerdi ;
| | - Xinming Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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14
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Double-barrel plugging in a recurrent aorto-enteric fistula. Indian J Thorac Cardiovasc Surg 2022; 38:422-425. [DOI: 10.1007/s12055-022-01342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022] Open
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15
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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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16
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Surgical approach to recurrent secondary aortoenteric fistulas: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:399-403. [PMID: 34589261 PMCID: PMC8462110 DOI: 10.5606/tgkdc.dergisi.2021.21518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.
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17
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Alreheili KM, Almutairi M, Alsaadi A, Ahmed G, Alhejili A, AlKhatrawi T. A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931013. [PMID: 34407064 PMCID: PMC8382025 DOI: 10.12659/ajcr.931013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Male, 2-year-old
Final Diagnosis: Aortoesophageal fistula
Symptoms: Esophageal foreign body • gastrointestinal bleeding
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology
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Affiliation(s)
- Khalid M Alreheili
- Department of Pediatrics, Division of Gastroenterology, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Mansour Almutairi
- Department of Pediatrics, Division of Cardiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | - Ali Alsaadi
- Department of Radiology, Division of Gastroenterology, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Ghousia Ahmed
- Department of Pediatrics, Division of Pediatric Intensive Care, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Abdulrahman Alhejili
- Department of Pediatrics, Division of Pediatric Intensive Care, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Taha AlKhatrawi
- Department of Pediatric Surgery, Maternity and Children's Hospital, Madinah, Saudi Arabia
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18
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Carrijo HB, Cunha JRF, Schuler CA, Borges MAP. Intraoperative endoprosthesis customization for repair of an aortoenteric fistula in an emergency context: a case report. J Vasc Bras 2021; 20:e20200179. [PMID: 34394205 PMCID: PMC8336980 DOI: 10.1590/1677-5449.200179] [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: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 12/05/2022] Open
Abstract
Aortoenteric fistula is a severe clinical condition and its management remains a major technical challenge for surgeons. In these cases, the conventional surgical approach is associated with high rates of morbidity and mortality. Endovascular surgery is an excellent option in these cases, but considering that the aorta has been treated previously, anatomy may not be compatible with commercially available endovascular devices and so physician-modified endografts may be needed in urgent cases. The case reported involves a secondary aortoenteric fistula, treated on an emergency basis with endovascular techniques, using a physician-modified endograft.
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Affiliation(s)
| | - Josué Rafael Ferreira Cunha
- Hospital de Base do Distrito Federal - HBDF, Brasília, DF, Brasil.,Instituto de Cardiologia do Distrito Federal - ICDF, Brasília, DF, Brasil
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19
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Jang JY, Jeon UB, Kim JH, Kim TU, Hwang JY, Ryu HS. Stent graft treatment of an ilioenteric fistula secondary to radiotherapy. Yeungnam Univ J Med 2021; 39:77-80. [PMID: 34229369 PMCID: PMC8895966 DOI: 10.12701/yujm.2021.01053] [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: 04/12/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.
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Affiliation(s)
- Joo Yeon Jang
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Ung Bae Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Jin Hyeok Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Jae Yeon Hwang
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Hwa Seong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Busan, Korea
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20
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Berner-Hansen V, Olsen AA, Brandstrup B. Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature. World J Gastrointest Endosc 2021; 13:189-197. [PMID: 34163566 PMCID: PMC8209543 DOI: 10.4253/wjge.v13.i6.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
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Affiliation(s)
- Victoria Berner-Hansen
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
| | - August A Olsen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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21
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Islam S, Ramnarine M, Harnarayan P, Maughn A, Naraynsingh V. Local Repair of a Secondary Aortoenteric Fistula in an Unstable Patient in a Resource-Poor Setting: A Case Report and Literature Review. Cureus 2021; 13:e14291. [PMID: 33968505 PMCID: PMC8096706 DOI: 10.7759/cureus.14291] [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] [Indexed: 11/25/2022] Open
Abstract
The presentation of a massive upper gastrointestinal bleed (UGIB) due to an aortoenteric fistula (AEF) is a rare occurrence. A high index of suspicion is required to rapidly make the diagnosis and execute prompt surgical management. Despite the many surgical options described, the survival rate continues to be low. Conventional surgical management is associated with a high morbidity and mortality. However, in emergencies, patients are unsuitable for major vascular surgery and may benefit from the less invasive staged procedure. This is a case report of a secondary aortoenteric fistula (SAEF) presenting as a massive UGIB, two years after an abdominal aortic aneurysm repair using a Dacron graft. Due to a lack of endovascular service in our setting, we proceeded with an upper gastrointestinal endoscopy followed by exploratory laparotomy. A damage control approach was chosen for our patient, i.e., local repair of the graft and aorta, as our patient was on double inotropes on the table. The patient died within 24 hours as a result of massive blood volume loss.
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Affiliation(s)
- Shariful Islam
- Department of General Surgery, San Fernando General Hospital, San Fernando, TTO.,Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Malini Ramnarine
- Department of General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO.,Department of General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Anthony Maughn
- Department of General Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO.,Surgery, Medical Associates Hospital, St. Joseph, TTO
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22
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Stafforini NA, Czerwonko ME, Singh N, Quiroga E, Starnes BW. Management of an Aortoenteric Fistula in a Patient with End Stage Renal and Liver Disease, Prior Endovascular Aortic Repair With Type II Endoleak. Vasc Endovascular Surg 2021; 55:752-755. [PMID: 33779400 DOI: 10.1177/15385744211004649] [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: 11/17/2022]
Abstract
Primary aortoenteric fistula (AEF) is an uncommon but life-threatening condition. We present a case of primary AEF in an octogenarian with previous endovascular aortic repair, type II endoleak and end stage liver and renal disease. He was successfully treated with accessory renal artery ligation, duodenojejunostomy, aneurysm sac debridement and irrigation and closure of the aneurysm sac over a drain. The patient made an excellent recovery and was discharged on POD #7, with no complications noted after over a year of follow up. This approach may represent a valuable option to manage primary AEF versus open endograft explant, particularly in severely ill patients.
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Affiliation(s)
- Nicolas A Stafforini
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Matias E Czerwonko
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Elina Quiroga
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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23
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Diagnostic and Management Difficulty of Bleeding Aorto-Duodenal Fistula Associated with Hodgkin's Lymphoma. Diagnostics (Basel) 2021; 11:diagnostics11030389. [PMID: 33668895 PMCID: PMC7996524 DOI: 10.3390/diagnostics11030389] [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: 01/17/2021] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Primary aorto-enteric fistula (AEF) resulting from abdominal malignancy is a rare and often fatal complication. The few reports to date are mostly secondary to solid tumors. We present a case of a patient with refractory Hodgkin's lymphoma who developed life-threatening AEF. We describe the diagnostic and therapeutic efforts, requiring a multi-disciplinary team of interventional radiology, gastroenterology, and transfusion medicine, resulting in a favorable outcome. Importantly, we offer several insights regarding the identification and management of high-risk patients, with an emphasis on pre-treatment considerations and urgent diagnosis and intervention.
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24
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Chen JF, Ochoa Chaar CI, Cardella J, Dardik A, Guzman RJ, Nassiri N. Emergent percutaneous chimney endovascular aortic repair of a secondary aortoenteric fistula in the setting of a solitary kidney. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:253-257. [PMID: 33997566 PMCID: PMC8095080 DOI: 10.1016/j.jvscit.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
Secondary aortoenteric fistula is a potentially lethal complication after aortic surgery. Traditional treatment consists of open graft excision with extra-anatomic bypass or in situ reconstruction. Patients who present in extremis, however, are generally poor candidates for re-do open aortic surgery. Endovascular repair has emerged as an alternative treatment modality for patients who would otherwise be unable to tolerate an extended operation. We report here a case of urgent endovascular repair of a juxtarenal secondary aortoenteric fistula via endovascular aneurysm repair with a renal artery chimney in a patient with a solitary kidney who presented in hemorrhagic and septic shock.
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Affiliation(s)
- Julia Fayanne Chen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, Conn
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25
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Hassan A, Khan A, Huasen B, Banihani M. Aortoenteric fistula after endovascular mycotic aortic aneurysm exclusion: lessons learned during the COVID-19 era. BMJ Case Rep 2021; 14:e238875. [PMID: 33547124 PMCID: PMC10577721 DOI: 10.1136/bcr-2020-238875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 01/08/2023] Open
Abstract
We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a 'bridging' endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.
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Affiliation(s)
- Ahmed Hassan
- Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Aazeb Khan
- Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Bella Huasen
- Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Mohamed Banihani
- Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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26
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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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27
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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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Imagami T, Sakamoto M, Kani H, Tadakoshi M. Lumbar artery aneurysm complicated by a fistula between the aneurysm and the duodenum in a patient with Leriche syndrome: A case report. Int J Surg Case Rep 2020; 77:580-583. [PMID: 33395850 PMCID: PMC7708768 DOI: 10.1016/j.ijscr.2020.11.087] [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: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022] Open
Abstract
The arterio-enteric fistula between lumbar artery and duodenum is rare pathology. Aneurysm may occur in the collateral circulation in patients with Leriche syndrome. Endovascular embolization can control hemorrhage immediately. Fistula closure and debridement is recommended for control of local infection. Endovascular embolization can serve as a landmark for the debridement of aneurysm.
Introduction Various collateral pathways maintain blood flow to the lower extremities in patients with Leriche syndrome. The occurrence of true aneurysms in the lumbar artery—a component of an extensive collateral circulation network in patients with Leriche syndrome—is extremely rare. Presentation of case A 73-year-old man with Leriche syndrome was diagnosed with lumbar artery aneurysm complicated by a duodenal fistula. The patient underwent endovascular repair, surgical duodenal fistula closure, and debridement of the aneurysm wall until coil exposure. Discussion With the same mechanism, patients with aortic occlusive disease may develop an aneurysm and arterio-enteric fistula in the collateral circulation. Combination of treatments may be important for hemostasis, control of infection, and maintaining adequate distal perfusion. Conclusion Endovascular embolization can control bleeding as well as serve as a landmark for the debridement of contaminated aneurysm. Surgical fistula closure and aneurysm-wall debridement are useful for control of local infection.
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Affiliation(s)
- Toru Imagami
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan.
| | - Masaki Sakamoto
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Hisanori Kani
- Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Masao Tadakoshi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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Arima D, Suematsu Y, Kurahashi K, Shimizu T, Nishi S, Yoshimoto A. Recurrence of Aortoenteric Fistula after Endovascular Aortic Repair. Ann Vasc Dis 2020; 13:90-92. [PMID: 32273930 PMCID: PMC7140165 DOI: 10.3400/avd.cr.19-00106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aortoenteric fistula (AEF) after endovascular aortic repair (EVAR) is a rare complication, with only 32 cases reported previously. A 71-year-old man who presented with severe duodenal bleeding due to primary AEF (PAEF) underwent successful EVAR. Four years later, the AEF recurred because of dilatation of the aneurysm sac. He underwent emergent surgery, removal of the stent graft, and replacement of an artificial bifurcated graft with placement of a greater omental flap. EVAR for PAEF was an effective option for acute treatment, but it caused refistulization in the long term. EVAR should be considered as a bridge therapy to definitive surgery.
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Affiliation(s)
- Daisuke Arima
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Yoshihiro Suematsu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Kanan Kurahashi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Takaharu Shimizu
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Akihiro Yoshimoto
- Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
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Jaffan AA, Larson J, Kapur S. Primary aortogastric fistula following Nissen fundoplication: A case report. Int J Surg Case Rep 2020; 77:890-893. [PMID: 33395918 PMCID: PMC7732966 DOI: 10.1016/j.ijscr.2020.11.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aortogastric fistula is rare however often fatal. Diagnosis is frequently missed or delayed, and usually made intra-operatively or during autopsy. High index of suspicion and CTA are key to diagnosis. Endoscopy and catheter angiography are often non diagnostic. Surgical repair is the gold standard therapy, but endovascular repair is becoming the preferred initial treatment.
Introduction Aortoenteric fistula (AEF) is a rare condition and consists of an abnormal communication between the aorta and the gastrointestinal (GI) tract. The duodenum is the most common location. Fistulas involving the stomach are very uncommon and account for only 2% of the cases. AEF typically results in rapid and fatal exsanguination as diagnosis is frequently missed or made too late (Bixby et al., 2018; Kougias et al., 2003; Lookman, 1959; Genc et al., 2000; Ong et al., 2019; Li et al., 2020). Presentation of case A 59 years old female with a history of Nissen fundoplication presented with lower gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) showed a large blood clot in the gastric fundus with no visible source of active bleeding. A mesenteric angiogram, performed for persistent gastro-intestinal bleeding and following two episodes of cardiac arrest, showed no evidence of active bleeding. The left gastric artery was prophylactically embolized. Persistent hemorrhage prompted an exploratory laparotomy followed by a left thoracotomy and confirmed the diagnosis of an aortogastric fistula (AGF). The patient expired intra-operatively. Discussion AGF is a very rare but often fatal condition (Busuttil and Goldstone, 2001). Computerized tomography angiography (CTA) can be a key to the diagnosis (Raman et al., 2012). EGD and catheter angiography have low sensitivity (Kuhara et al., 2015; Manduch et al., 2008). Definitive diagnosis is usually made during surgical exploration or autopsy (Wasvary et al., 1997). While open surgical repair is considered the gold standard therapy, endovascular therapy is becoming the preferred initial treatment option (Bixby et al., 2018). Conclusion AGF should be considered in the differential diagnosis of GI bleeding, especially in patients with massive hemorrhage where EGD and mesenteric angiography are not diagnostic.
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Management of abdominal aortic prosthetic graft and endograft infections. A multidisciplinary update. J Infect Chemother 2019; 25:669-680. [DOI: 10.1016/j.jiac.2019.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
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Davie M, Yung DE, Plevris JN, Koulaouzidis A. Aortoenteric fistula: a rare but critical cause of small bowel bleeding discovered on capsule endoscopy. BMJ Case Rep 2019; 12:12/5/e230083. [PMID: 31068354 DOI: 10.1136/bcr-2019-230083] [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: 11/04/2022] Open
Abstract
A 78-year-old man attended for outpatient capsule endoscopy, to investigate a recent history of unexplained small bowel bleeding. His previous medical history included an abdominal aortic aneurysm repair 6 years ago. Soon after capsule ingestion, he experienced sudden onset abdominal pain and collapsed on hospital grounds. He was rapidly transferred to the emergency department as he was haemodynamically unstable, and a significant per rectum (PR) bleed was found on examination. The patient was quickly stabilised following fluid resuscitation. CT angiography was performed which did not show active bleeding. However, use of the real-time capsule viewer indicated a profuse active jejunal bleed originating from the aortic graft, suggestive of an aortoenteric fistula. The patient underwent emergency endovascular cuff placement, and subsequent endovascular abdominal aortic stent grafting, to good effect.
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Affiliation(s)
- Matt Davie
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John N Plevris
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.,Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, UK
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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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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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Jiang C, Chen X, Li J, Li H. A case report of successful treatment of secondary aortoenteric fistula complicated with gastrointestinal bleeding and retroperitoneal abscess in an elderly patient. Medicine (Baltimore) 2018; 97:e11055. [PMID: 29901606 PMCID: PMC6024772 DOI: 10.1097/md.0000000000011055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE The treatment of secondary aortoenteric fistula (SAEF) involves maintaining hemodynamic stability, infection control, revascularization, and surgical repair. Conventional open repair is associated with high mortality, whereas endovascular stent-graft repair is associated with recurrent infection or bleeding. PATIENT CONCERNS We report the case of an 85-year-old man with SAEF who presented with gastrointestinal bleeding and retroperitoneal abscess. DIAGNOSES He was misdiagnosed for 5 months. SAEF was eventually diagnosed by CT and gastroduodenoscopy. INTERVENTIONS The patient underwent hybrid open surgery: extraanatomic left axillofemoral bypass graft reconstruction, exploratory laparotomy, aortic stent graft excision, infrarenal abdominal aortic suture, left common iliac artery ligation, extensive surgical debridement, and retroperitoneal abscess resolution and drainage, along with duodenal defect repair and jejunal feeding tube placement. OUTCOMES He survived the complicated surgery and several life-threatening complications with multidisciplinary management. He has kept well for 15 months. LESSONS Elderly SAEF patients can undergo open repair when circumstances permit, but multidisciplinary management is crucial.
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Affiliation(s)
| | | | - Jianshe Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
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36
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Partovi S, Trischman T, Sheth RA, Huynh TTT, Davidson JC, Prabhakar AM, Ganguli S. Imaging work-up and endovascular treatment options for aorto-enteric fistula. Cardiovasc Diagn Ther 2018; 8:S200-S207. [PMID: 29850432 DOI: 10.21037/cdt.2017.10.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aorto-enteric fistula (AEF) is a rare life-threatening condition. Early recognition and diagnosis are of paramount importance to improve outcome. In this article four cases of AEF with relevant pre- and post-procedural images are presented to demonstrate the utility of cross-sectional imaging in the work-up of AEF. The literature is reviewed to describe the typical presentation of AEF, the diagnostic work-up of AEF, and the different methods used to treat AEF. Endovascular repair of AEF is gaining increasing attention due to its decreased short-term mortality compared to open surgical techniques.
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Affiliation(s)
- Sasan Partovi
- Section of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thomas Trischman
- Section of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Tam T T Huynh
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jon C Davidson
- Section of Interventional Radiology, Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wei XQ, Song L, Zhang XS, Wang KY, Wu J. Endovascular stent graft repair of aortogastric fistula caused by peptic ulcer after esophagectomy: A case report. Medicine (Baltimore) 2017; 96:e8959. [PMID: 29390289 PMCID: PMC5815701 DOI: 10.1097/md.0000000000008959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
RATIONALE Aortogastric fistula (AGF) is a rare but devastating clinical complication after esophagectomy. In a recent report, nearly all AGF patients died of massive hemorrhage or aspiration of massive hematemesis. Therefore, timely appropriate treatment of AGF remains a challenge.Herein, we report a case of AGF that resulted from peptic ulceration after esophagectomy and was successfully treated with endovascular stent graft placement. PATIENT CONCERNS A 59-year-old man had undergone video-assisted thoracoscopic esophagectomy for squamous cell carcinoma and esophageal reconstruction using a gastric tube 14 months previously. He suddenly experienced massive hematemesis and unstable circulatory dynamics, Infusion was performed to treat critical hemorrhagic shock but was ineffective. We informed the patient and his family members of the situation, and once written informed consent to treatment was provided, we rushed him to the operating room. DIAGNOSES Contrast medium permeated into the gastric cavity through a fistula between the abdominal aorta and gastric tube at the 11th thoracic level, Based on this, we made a diagnosis of AGF resulting from a peptic ulcer, and this diagnosis was further confirmed by high pressure angiography combined with computed tomography (CT) imaging. INTERVENTIONS An endovascular stent graft was placed under the guidance of digital subtraction angiography and followed by antibiotic therapy to prevent infection and proton pump inhibitor therapy to inhibit gastric acid secretion. OUTCOMES The patient recovered uneventfully after the procedure. Four months after surgery, the patient died of organ failure caused by retroperitoneal lymph node metastasis and multiple intrahepatic metastases, with no postoperative bleeding linked to the endovascular stent graft repair. LESSONS Our case supports the notion that endovascular stent graft repair is a feasible alternative in treatment of AGF with several advantages in addition to surgical intervention, although more such cases should be collected and analyzed in the future to corroborate our observations.
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Beuran M, Negoi I, Negoi RI, Hostiuc S, Paun S. Primary Aortoduodenal Fistula: First you Should Suspect it. Braz J Cardiovasc Surg 2017; 31:261-263. [PMID: 27737411 PMCID: PMC5062716 DOI: 10.5935/1678-9741.20160049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/30/2016] [Indexed: 01/16/2023] Open
Abstract
A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition. The postoperative recovery was uneventful, with discharge after 12 days.
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Affiliation(s)
- Mircea Beuran
- Carol Davila University of Medicine and Pharmacy Bucharest, General Surgery Department, Emergency Hospital of Bucharest, Romania
| | - Ionut Negoi
- Carol Davila University of Medicine and Pharmacy Bucharest, General Surgery Department, Emergency Hospital of Bucharest, Romania
| | | | - Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy Bucharest, Mina Minovici National Institute of Legal Medicine, Romania
| | - Sorin Paun
- Carol Davila University of Medicine and Pharmacy Bucharest, General Surgery Department, Emergency Hospital of Bucharest, Romania
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Spanos K, Kouvelos G, Karathanos C, Matsagkas M, Giannoukas AD. Current status of endovascular treatment of aortoenteric fistula. Semin Vasc Surg 2017; 30:80-84. [PMID: 29248124 DOI: 10.1053/j.semvascsurg.2017.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastrointestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF. When endovascular treatment is applied where appropriate, early outcomes seem to be superior compared to open surgery. This benefit may be lost during long-term follow-up, implying that a staged approach with early conversion to in situ grafting may realize the best patient survival and morbidity. Lifelong administration of antibiotics is associated with a reduction in re-infection. An endovascular approach used as a bridging procedure in unstable patients is recommended, followed by definitive open therapy, if feasible, in patients with good life expectancy.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - George Kouvelos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Miltiadis Matsagkas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece.
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Endovascular Repair with a Stent Graft in a Patient with Aortoduodenal Fistula after Radiation Therapy. Case Rep Radiol 2017; 2017:2087142. [PMID: 29181216 PMCID: PMC5664233 DOI: 10.1155/2017/2087142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/04/2017] [Accepted: 09/24/2017] [Indexed: 12/31/2022] Open
Abstract
Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention and represents a rare but critical cause of repeated and massive gastrointestinal bleeding. Primary ADF often occurs as a result of atherosclerotic aneurysm and infection, but ADF involving a normal-size aorta is rare; furthermore, ADF related to radiation therapy is extremely rare. We present the case of a 56-year-old man with a history of bowel obstruction due to radiation enteritis who was admitted with severe hematemesis and hemorrhagic shock. Gastroduodenal endoscopy and contrast-enhanced computed tomography findings were unremarkable. Aortoduodenal fistula was suspected based on the diffuse calcification of the abdominal aorta confined to the radiation field and the presence of an aortoduodenal communication on angiography. Endovascular repair with a stent graft seemed to be a safer option than open surgery and was suited to the rapid control of bleeding from ADF because of the patients' unstable hemodynamic state and the presence of intestinal adhesions. The fistula was successfully sealed by endovascular stent graft placement. Hematemesis did not recur postoperatively and anemia gradually improved. The patient died from pneumonia 33 days later.
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Lara-Hernández R, Riera Vázquez R, Benabarre Castany N, Sanchis P, Lozano Vilardell P. Ureteroarterial Fistulas: Diagnosis, Management, and Clinical Evolution. Ann Vasc Surg 2017; 44:459-465. [DOI: 10.1016/j.avsg.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
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“In situ” endografting in the treatment of arterial and graft infections. J Vasc Surg 2017; 65:1824-1829. [DOI: 10.1016/j.jvs.2016.12.134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
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Paulasir S, Khorfan R, Harsant C, Anderson HL. Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding. BMJ Case Rep 2017; 2017:bcr-2016-218892. [PMID: 28446485 DOI: 10.1136/bcr-2016-218892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.
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Affiliation(s)
- Sylvester Paulasir
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - Rhami Khorfan
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
| | - Christina Harsant
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
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Han K, Lee DY, Kim MD, Lee S, Won JY, Kwon JH, Choi D, Ko YG. Hybrid Treatment: Expanding the Armamentarium for Infected Infrarenal Abdominal Aortic and Iliac Aneurysms. J Vasc Interv Radiol 2017; 28:564-569. [DOI: 10.1016/j.jvir.2016.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022] Open
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Gombert A, Grommes J, Schick G, Binnebösel M, Klink C, Jacobs MJ, Kotelis D. Sarcoidosis-Associated Aortoesophageal Fistula—Multistage Interdisciplinary Surgical Therapy for a Rare and Life-Threatening Condition. Ann Vasc Surg 2017; 39:287.e15-287.e20. [DOI: 10.1016/j.avsg.2016.06.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 02/09/2023]
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis. Eur J Vasc Endovasc Surg 2016; 52:770-786. [PMID: 27838156 DOI: 10.1016/j.ejvs.2016.09.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). METHODS This study is a review and pooled data analysis. Medline and Scopus databases were searched for studies published between 1999 and 2015. Particular emphasis was given to short- and long-term outcomes in relation to AEF repair type. RESULTS Two hundred and sixteen publications were retrieved, reporting on 823 patients. In-hospital mortality was 30.7%. Open surgery had higher in-hospital mortality (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3-14.7, including staged endovascular to open surgery, 0/13, 0%). In-hospital mortality after graft removal/extra-anatomical bypass grafting was 31.2% (66/226), graft removal/in situ repair 34% (137/403), primary closure of the arterial defect 62.5% (10/16), and for miscellaneous open procedures 41.3% (33/80), p = .019. Among the subgroups of in situ repair, homografts were associated with a higher mortality than impregnated prosthetic grafts (p = .047). There was no difference in recurrent AEF-free rates between open and endovascular procedures. Extra-anatomical bypass/graft removal and in situ repair had a lower AEF recurrence rate than primary closure and homografts. Late sepsis occurred more often after endovascular surgery (2-year rates 42% vs. 19% for open, p = .001). The early survival benefit of endovascular surgery was blunted during follow-up, although it remained significant (p < .001). Within the in situ repair group, impregnated prosthetic grafts were associated with the worst overall and AEF related mortality free rates and vein grafts with the best. No recurrence, sepsis, or mortality was reported following staged endograft placement to open repair after a mean follow-up of 16.8 months (p = .18, p = .22, and p = .006, respectively, compared with patients in other groups). CONCLUSIONS Endovascular surgery, where appropriate, is associated with better early survival than open surgery for secondary AEFs. Most of this benefit is lost during long-term follow-up, implying that a staged approach with early conversion to in situ vein grafting may achieve the best results in selected patients.
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Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Greece; Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
| | - C D Bicknell
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - D Bergqvist
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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48
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Hashimoto M, Goto H, Akamatsu D, Shimizu T, Tsuchida K, Kawamura K, Tajima Y, Umetsu M. Long-Term Outcomes of Surgical Treatment with In Situ Graft Reconstruction for Secondary Aorto-Enteric Fistula. Ann Vasc Dis 2016; 9:173-179. [PMID: 27738458 DOI: 10.3400/avd.oa.16-00082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: The optimal surgical management for secondary aorto-enteric fistula (sAEF) is controversial. Here, we report the long-term outcomes of a surgical treatment with in situ graft reconstruction for sAEF that was performed at our hospital. Methods: Between 2009 and 2012, 10 consecutive patients (8 males, 2 females, mean age 75.9 years) with sAEF were surgically treated with in situ graft reconstruction. Perioperative and long-term outcomes were reviewed retrospectively by medical records. Results: Clinical manifestations, including gastrointestinal bleeding, shock, sepsis, and back and abdominal pain, were observed during the treatment of the patients. In all the cases, the fistula was found between the duodenum or small intestine and the graft anastomosis, the graft itself, or pseudoaneurysm. Total graft excision and in situ graft reconstruction with omental coverage and digestive tract reconstruction was performed for all cases. There were two operative deaths because of multiple organ dysfunction syndrome and sepsis. The other patients showed no sAEF related complications, such as graft infection, and were alive during the 54-month mean follow-up period (33-76 months). Conclusion: According to our study, the long-term outcomes of surgical treatment with in situ graft reconstruction for sAEF were considered satisfactory. (This article is a translation of Jpn J Vasc Surg 2016; 25: 1-6.).
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Affiliation(s)
- Munetaka Hashimoto
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hitoshi Goto
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Daijirou Akamatsu
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takuya Shimizu
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Ken Tsuchida
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Keiichiro Kawamura
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Yuta Tajima
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Michihisa Umetsu
- Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan
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49
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Yamamoto Y, Igari K, Toyofuku T, Kudo T, Inoue Y. Late Stent Graft Infection after the Emergency Endovascular Repair of a Secondary Iliac Artery-Enteric Fistula Treated with Graft Removal and In Situ Aortic Reconstruction Using Femoral Veins. Ann Thorac Cardiovasc Surg 2016; 23:113-117. [PMID: 27396381 DOI: 10.5761/atcs.cr.16-00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An arterioenteric fistula is a devastating and life-threatening condition that requires urgent treatment. Less-invasive endovascular treatment has emerged as an alternative to conventional open repair, but postoperative graft infection remains a major concern. We herein report a case of late stent graft infection after emergency endovascular repair of a secondary iliac artery-enteric fistula. The patient was a 63-year-old male who presented with a fever, who had undergone successful endovascular stent grafting for a secondary common iliac artery-enteric fistula 29 months prior. The diagnosis of a stent graft infection was confirmed via computed tomography. He underwent graft removal and in situ reconstruction with femoral vein grafts. At 6-month follow-up, the patient is in a good general condition without any symptoms.
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Affiliation(s)
- Yohei Yamamoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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50
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Inoue K, Fukunaga R, Matsubara Y, Aoyagi Y, Matsuda D, Kyuragi R, Morisaki K, Matsumoto T, Oki E, Maehara Y. Primary aortoduodenal fistula with a history of distal gastrectomy. Acute Med Surg 2016; 4:105-108. [PMID: 29123844 PMCID: PMC5667283 DOI: 10.1002/ams2.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 05/05/2016] [Indexed: 01/08/2023] Open
Abstract
Case A 69‐year‐old man was transferred to our hospital because of an aortoduodenal fistula with hematemesis and pre‐shock vital signs. He had a history of alcoholism, malnutrition, and distal gastrectomy and Billroth I reconstruction. Endovascular aneurysm repair was successfully carried out; however, the presence of comorbidities affected further radical treatment. Outcome The patient survived for 2 months postoperatively. Conclusion Endovascular aneurysm repair is a useful first‐line treatment for high‐risk aortoduodenal fistula patients; however, it requires improvement for long‐term outcomes in complicated high‐risk cases.
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Affiliation(s)
- Kentaro Inoue
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Ryota Fukunaga
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yutaka Matsubara
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yukihiko Aoyagi
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Daisuke Matsuda
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Ryoichi Kyuragi
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Koichi Morisaki
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Takuya Matsumoto
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Eiji Oki
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science Graduate School of Medical Sciences Kyushu University Fukuoka Japan
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