1
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Lee S, Hwang D, Yun WS, Huh S, Kim HK. Misdiagnosis of Primary Iliac Aneurysmo-Colonic Fistula as a Submucosal Tumor Leading to Delayed Treatment: A Case Report. Vasc Endovascular Surg 2024:15385744241257597. [PMID: 38820567 DOI: 10.1177/15385744241257597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
An aortoenteric fistula (AEF) is an uncommon cause of gastrointestinal bleeding that requires prompt diagnosis and intervention owing to its high mortality rate. Moreover, iliac aneurysmo-colonic fistula is an exceptionally infrequent presentation. We report a unique case of a 71-year-old male presenting with hematochezia, later diagnosed with a primary fistula between a common iliac artery aneurysm and the sigmoid colon. Initially, the patient was misdiagnosed as having a gastrointestinal stromal tumor, leading to delayed and emergent surgical intervention due to massive bleeding 2 days later. This case is particularly notable for its rarity, misinterpretation of the initial diagnosis, complicated surgical procedures, and development of complications including ischemic myopathy. This case highlights the criticality of accurate diagnosis with a high index of suspicion, significance of consultation with a vascular surgeon for vascular abnormalities, and importance of considering ischemic time in the sequence of surgical treatments to ensure timely and appropriate management.
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Affiliation(s)
- Sangho Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Deokbi Hwang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo-Sung Yun
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Huh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyung-Kee Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
- Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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2
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Stanley B, Nguyen V, Sivasuthan G, Burstow M. Massive gastrointestinal bleed due to a primary aortoenteric fistula. BMJ Case Rep 2024; 17:e258320. [PMID: 38378584 PMCID: PMC10882345 DOI: 10.1136/bcr-2023-258320] [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: 02/22/2024] Open
Abstract
A man in his 60s attended emergency for acute-onset abdominal pain and haematemesis. Requiring resuscitation, a CT abdomen/pelvis revealed a primary aortoenteric fistula actively bleeding into the duodenum. His background included a previous severe Q-fever infection and a heavy smoking history. Despite attempts at resuscitation and an emergent surgical attempt at haemostasis, the patient did not survive the massive gastrointestinal haemorrhage.Even in less severe cases, management of aortoenteric fistulas is tricky. Blood cultures and angiographic imaging are important investigations in guiding surgical approach. The pathology tends to have a significant rate of mortality even at tertiary-level vascular surgical centres.
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Affiliation(s)
- Benjamin Stanley
- Logan Hospital, Logan, Queensland, Australia
- Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
| | | | | | - Matthew Burstow
- Department of General Surgery, Logan Hospital, Logan, Queensland, Australia
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3
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González-Sagredo A, Busquets J, Carnaval T, Romera-Villegas A, Santin M, Videla S, Vila R, Iborra E. Lessons learned in aortoenteric fistula repair: a multidisciplinary team approach and diagnostic-therapeutic algorithm matter. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:533-535. [PMID: 36562523 DOI: 10.17235/reed.2022.9403/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aortoenteric fistula (AEF) is a low-prevalence, life-threatening condition regardless of treatment, with a 30-50% postoperative (≤60 days) mortality. This study aimed to estimate our postoperative cumulative mortality incidence and assess the feasibility of the diagnostic-therapeutic algorithm used in our clinical practice. We performed a retrospective cohort study of patients treated for AEF at a fully-equipped tertiary healthcare center between January 2008 and December 2020.
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Affiliation(s)
| | - Juli Busquets
- Digestive and General Surgery , Hospital Universitari de Bellvitge, Spain
| | - Thiago Carnaval
- Pathology and Experimental Therapeutics, Universitat de Barcelona, Spain
| | | | - Miguel Santin
- Infectious Diseases , Hospital Universitari de Bellvitge, Barcelona
| | - Sebastián Videla
- Clinical Research Support Unit, Bellvitge University Hospital, Spain
| | - Ramón Vila
- Angiology and Vascular Surgery , Hospital Universitari de Bellvitge, Spain
| | - Elena Iborra
- Angiology and Vascular Surgery , Hospital Universitari de Bellvitge, Spain
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4
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Martino A, Di Serafino M, Orsini L, Giurazza F, Fiorentino R, Crolla E, Campione S, Molino C, Romano L, Lombardi G. Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review. World J Gastroenterol 2023; 29:4222-4235. [PMID: 37545636 PMCID: PMC10401659 DOI: 10.3748/wjg.v29.i27.4222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/11/2023] [Accepted: 05/09/2023] [Indexed: 07/13/2023] Open
Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management. However, NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines, with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment. Conversely, the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines. Given they are frequently life-threatening conditions, all the involved clinicians, that is emergency physicians, diagnostic and interventional radiologists, surgeons, in addition obviously to gastroenterologists, should be aware of and familiar with their management. Indeed, they typically require a prompt diagnosis and treatment, engaging a dedicated, patient-tailored, multidisciplinary team approach. The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.
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Affiliation(s)
- Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Luigi Orsini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Francesco Giurazza
- Department of Interventional Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | | | - Enrico Crolla
- Department of Oncological Surgery, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Severo Campione
- Department of Pathology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Carlo Molino
- Department of Oncological Surgery, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
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5
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Das S, Prakash S, Singh S, Shaikh O, Balasubramanian G. Aortoesophageal Fistula Occurring Due to Aortic Aneurysm. Cureus 2023; 15:e42148. [PMID: 37602018 PMCID: PMC10438792 DOI: 10.7759/cureus.42148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Upper gastrointestinal bleeding is a rare presentation of the aortoesophageal fistula (AEF) and is usually caused by thoracic aortic aneurysms. We present the case of a 61-year-old male who presented with chest pain and hematemesis. A chest X-ray showed a widened mediastinum. The patient underwent computed tomography angiography (CTA), which showed the presence of a large aneurysm in the aorta, which caused compression of the trachea, esophagus, and left pulmonary artery. Additionally, there was evidence of an AEF. It was decided to perform an emergency surgical intervention on the patient. However, the patient had multiple episodes of hematemesis and expired.
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Affiliation(s)
- Snehasis Das
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Shweta Singh
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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6
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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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7
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Rigueiro López L, Castro Vázquez J, Loureiro González C, Leturio Fernández S, Díez Del Val I. Aortoesophageal fistula after laparoscopic total gastrectomy. Cir Esp 2022; 100:798-800. [PMID: 36064175 DOI: 10.1016/j.cireng.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/17/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Lucía Rigueiro López
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Ourense, Ourense, Spain.
| | - Joseba Castro Vázquez
- Sección de Cirugía Esofagogástrica, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | | | | | - Ismael Díez Del Val
- Sección de Cirugía Esofagogástrica, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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8
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Muacevic A, Adler JR. Primary Aortoesophageal Fistula Presenting as Upper Gastrointestinal Bleed. Cureus 2022; 14:e30018. [PMID: 36348888 PMCID: PMC9637265 DOI: 10.7759/cureus.30018] [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] [Accepted: 10/06/2022] [Indexed: 11/18/2022] Open
Abstract
Aortoenteric fistula is a rare condition that can be primary or secondary. The primary type is less common than the secondary. The secondary aortoenteric fistula is an uncommon fatal complication after reconstructive surgery for an aortic aneurysm or other aortic diseases. Here we present a case of a 59-year-old man who presented to our emergency department with sudden onset of massive hematemesis. Imaging studies were done and the patient was diagnosed to have aortoesophageal fistula. Upper gastrointestinal endoscopy showed an intraluminal bulge in the posterior wall of the esophagus with an ulcer and hematoma. The patient was planned for emergency surgical intervention, but the patient had recurrent bouts of hematemesis and, unfortunately, expired. Hence patients presenting with massive hematemesis, aortoenteric fistula can be the underlying cause, and all surgeons should be aware of such conditions and the need for emergent surgical intervention.
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9
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Busch M, Stahl K, Fuge J, Schrimpf C, RIttgerodt N, Greer M, Mederacke YS, Haverich A, Wedemeyer H, Heidrich B, Schneider A, Lenzen H, Mederacke I. Out of sight for the endoscopist? Gastrointestinal bleeding after aortic repair. Scand J Gastroenterol 2022; 57:1112-1119. [PMID: 35527697 DOI: 10.1080/00365521.2022.2062258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIM Secondary Aortoenteric Fistulas (sAEF) are difficult to diagnose and usually result in fatal gastrointestinal (GI) bleeding following aortic repair. Outcomes are largely dependent on a timely diagnosis, but AEFs remain challenging to identify endoscopically and are usually diagnosed on computed tomography (CT) scans. The aim of our study was optimize diagnosis of AEF by identifying patients developing GI bleeding after aortic repair, investigate their clinical course and identify factors specific to different bleeding sources. METHODS A retrospective, single-center study capturing all patients developing upper or lower GI bleeding after aortic surgery between January 2009 and March 2020 was performed. Electronic health records were screened for diagnostic codes of the relevant procedures. Bleeding was classified into three groups: AEF with demonstrable fistula, ischemic - macroscopic ulceration plus histological confirmation or imaging and "other" due to other recognized conventional cause, such as peptic ulcer disease. RESULTS 47 GI bleeding episodes in 39 patients were identified. Of these, 10 episodes (21%) were caused by AEF, 16 (34%) by ischemic ulceration and 21 (45%) due to other causes. Patients with AEF exhibited more frequent hemodynamic instability requiring vasopressors and had higher mortality, while ischemic ulcerations were associated with more recent operation or hypotensive episode. CONCLUSIONS GI bleeding complications are uncommon following aortic surgery. AEF and ischemic ulceration are however frequent bleeding causes in this cohort. In patients presenting with fulminant bleeding, primary CT-scanning should be considered.
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Affiliation(s)
- Markus Busch
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Claudia Schrimpf
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nina RIttgerodt
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Young-Seon Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Heart-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Schneider
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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10
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REIS ACF, ROMANINI SG, RAMPAZZO NETO A, TRENTINI B, AUN R, ARDENGH JC. DUODENAL INVOLVEMENT RELATED TO VASCULAR COMPLICATIONS: DIAGNOSED BY UPPER GASTROINTESTINAL ENDOSCOPY. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:157-158. [DOI: 10.1590/s0004-2803.202200001-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | | | - José Celso ARDENGH
- Hospital 9 de Julho, Brasil; Universidade de São Paulo Ribeirão Preto, Brasil
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11
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Lee HY, Tung YC, Lee CH. Recurrent bacteremia as presentation from an aorto-duodenal fistula after endovascular aneurysm repair. IDCases 2022; 29:e01566. [PMID: 35859941 PMCID: PMC9293623 DOI: 10.1016/j.idcr.2022.e01566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hsing-yun Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Cheng Tung
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Correspondence to: 123, Ta Pei Rd.,Niao Sung District, Kaohsiung, 833, Taiwan.
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12
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Yagi M, Aiboshi J, Kojima M, Yoshikawa S, Morishita K, Kaji M, Otomo Y. Life‐saving case of cardiopulmonary arrest by secondary aortoenteric fistula formed in the anastomotic site between the inferior mesenteric artery and aortic graft. Acute Med Surg 2022; 9:e2744. [PMID: 35356485 PMCID: PMC8948498 DOI: 10.1002/ams2.744] [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: 11/12/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Secondary aortoenteric fistula is a fatal cause of gastrointestinal bleeding after aortic reconstructive surgery with a prosthesis. In most cases, the proximal suture line is involved. We herein report a rare case in which the fistula formed between the suture line of inferior mesenteric artery reimplantation and the jejunum. Case Presentation An 82‐year‐old man was transferred to our hospital due to hematemesis with severe hypovolemic shock. Although he fell into cardiopulmonary arrest, immediate resuscitation achieved return of spontaneous circulation. As his surgical history of aortic reconstruction and computed tomography findings suggested potential secondary aortoenteric fistula, emergency surgery was carried out. The anastomosis between the inferior mesenteric artery and aortic graft was communicating with the jejunum. Partial jejunal resection was undertaken, and the aortic graft was replaced. Conclusion The anastomosis between the inferior mesenteric artery and aortic graft in the previous aortic replacement can become the site of secondary aortoenteric fistula.
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Affiliation(s)
- Masayuki Yagi
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Mitsuaki Kojima
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Shunsuke Yoshikawa
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Masahito Kaji
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Medical Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
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13
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Dorpmans D, Peeters K, Mufty H, Debaveye Y, Van Wijngaerden E, Fourneau I. Vascular Graft Infections With Candida: A Factor for Increased Mortality in in-situ Reconstructions. Ann Vasc Surg 2021; 82:206-211. [PMID: 34902469 DOI: 10.1016/j.avsg.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The empiric antibiotic regimen started after deep cultures and explantation of the graft mostly do not cover antifungals. We retrospectively studied the outcome of candida compared to non-candida VGI and assessed whether these results could justify the addition of antifungals to the empiric antibiotics in the early postoperative period. METHODS All patients treated for infected aorto(ilio)femoral graft with excision and reconstruction at the vascular department of University Hospitals Leuven between January 2010 and 2017 (n = 56) were studied retrospectively. Patients were allocated to the candida group (n = 10) or non-candida group (n = 46) according to the presence of Candida in deep culture isolates. RESULTS All-cause mortality was significantly higher in the candida group compared to the non-candida group. All-cause 30-day mortality was 40% and 13% for both groups respectively (P = 0.066). At 5 years this was 90% and 46% respectively (P = 0.014). In the candida group 6 patients (60%) had to be revised in the operating room due to bleeding, compared to 5 patients (11%) in the non-candida group (P = 0.002). Two patients (20%) and 5 patients (11%) had to be readmitted to the ICU, respectively. CONCLUSION Survival of candida related VGI is significantly worse, especially in the first 5 postoperative months. This could justify the addition of an antifungal to the early empiric postoperative antibiotic cocktail, especially in patients with an aorto-enteric fistula. A cost-benefit analysis could be useful to evaluate the yield.
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Affiliation(s)
- Dries Dorpmans
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karen Peeters
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium..
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14
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Rigueiro López L, Castro Vázquez J, Loureiro González C, Leturio Fernández S, Díez del Val I. Fístula aortoesofágica posgastrectomía total laparoscópica. Cir Esp 2021. [DOI: 10.1016/j.ciresp.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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HOCAGİL H, HOCAGİL AC. Case Report; Primary Aortoenteric Fistula Due to Plum Kernel. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.1009451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Lakhani DA, Sharma SA, Kutayni H, Balar AB, Marano G, Martin D. Primary aortoenteric fistula: A case report and brief review of the literature. Radiol Case Rep 2021; 16:3549-3553. [PMID: 34567331 PMCID: PMC8449087 DOI: 10.1016/j.radcr.2021.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Aortoenteric fistula is a life-threatening emergency and is associated with high morbidity and mortality. Prompt surgical intervention before the aneurysm ruptures lowers the mortality rate to about 50%. Potential imaging mimics for aortoenteric fistula include retroperitoneal fibrosis, mycotic aortic aneurysm, and infectious aortitis. Secondary aortoenteric fistula has relative higher incidence compared to primary and is more common with open aortic repair versus endovascular stent graft repair. Ectopic gas in the aneurysm sac and extravasation of enteric contrast into the aneurysm sac is diagnostic for aortoenteric fistula. However, enteric contrast is not recommended for routine evaluation of aortoenteric because the aforementioned finding is extremely rare. More common imaging findings include bowel loop appearing adherent to aneurysm sac with associated inflammatory stranding and foci or ectopic gas within the aneurysm sac or interposed between the bowel and aneurysm sac. Here we present a case of 52-year-old male who presents with incidental primary aortoenteric fistula.
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17
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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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Bartley A, Scali ST, Patterson S, Rosenthal MD, Croft C, Arnaoutakis DJ, Cooper MA, Upchurch GR, Back MR, Huber TS. Improved perioperative mortality after secondary aorto-enteric fistula repair and lessons learned from a 20-year experience. J Vasc Surg 2021; 75:287-295.e3. [PMID: 34303801 DOI: 10.1016/j.jvs.2021.07.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Secondary aorto-enteric fistulas (SAEFs) are rare but represent one of the most challenging and devastating problems for vascular surgeons. Several issues surrounding SAEF treatment remain unresolved, including optimal surgical reconstruction and conduit choice. We performed an audit of our experience with SAEFs and highlight aspects of care that have affected outcomes over time with the intent to identify factors associated with best outcomes. METHODS We performed a single center, retrospective review of all consecutive SAEF repairs (1999-2019), defined as presence of a false communication between an enteric structure and pre-existing aortic graft. The primary endpoint was 30-day mortality. Secondary endpoints included incidence of complications and overall survival. Time-dependent outcome comparison was performed. Cox proportional hazards modeling and life-table analysis estimated risk and freedom from endpoints. RESULTS A total of 57 patients (63% male; n = 36) presented with SAEF (median age, 69 years; interquartile range [IQR], 61-74 years). Median follow-up time was 10 months (interquartile range, 3-21 months. The most common presenting symptoms were gastrointestinal bleeding (60%; n = 34) and abdominal pain (56%; n= 3 2). For the overall cohort, 30% (n = 17) underwent extra-anatomic bypass with aortic ligation, 30% (n = 17) rifampin-soaked Dacron graft, 26% (n = 15) femoral vein (eg, neoaortoiliac system), and 14% (n = 8) cryopreserved aortic allograft. The enteric communication involved the duodenum in 85% (n = 48), and a double-layer hand-sewn primary repair was most commonly employed (61%; n = 35). Thirty-day mortality was 35% (n = 20) with no significant difference between 90 days (39%; n = 22) and 180 days (42%; n = 24). Morbidity was 70% (n = 40), with gastrointestinal (30%; n = 17; leak [9%]), pulmonary (25%; n = 14), and renal (21%) complications being most common. Incidence of reoperation for any vascular and/or gastrointestinal-related complication was 56% (n = 32). One-year and 3-year survival was 54% ± 6% and 48% ± 8%, respectively. Over time, 30- and 90-day mortality improved (odds ratio, 0.1; 95% confidence interval, 0.4-0.5; P = .002) despite no change in patient factors, operative strategy, conduit choice, or morbidity rate. Prehospital history of gastrointestinal bleeding was associated with worse survival (hazard ratio, 2.0; 95% confidence interval, 1.0-3.9; P = .06); however, reconstruction strategy (in-situ vs extra-anatomic bypass), postoperative gastrointestinal and/or vascular complication, omental flap use, and preoperative endovascular aneurysm repair history were not associated with outcome. CONCLUSIONS In conclusion, we observed improved short-term mortality despite no significant change in patient presentation or postoperative complications. This highlights increasing institutional experience in selecting the optimal surgical strategy and improved ability to rescue patients experiencing adverse postoperative events. An individualized approach to reconstruction and conduit choice can lead to best outcomes after SAEF management when patients are treated at a high-volume aortic surgery center.
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Affiliation(s)
- Akeem Bartley
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla; Malcolm Randall Veterans Affairs Hospital, Gainesville, Fla.
| | - Suzannah Patterson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Martin D Rosenthal
- Division of Trauma and Acute Care Surgery, University of Florida, Gainesville, Fla
| | - Chasen Croft
- Division of Trauma and Acute Care Surgery, University of Florida, Gainesville, Fla
| | - Dean J Arnaoutakis
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Michol A Cooper
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
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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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Fuchigami J, Miyamoto K, Shibata N, Yonemitsu T, Ueda K, Kato S. Aortoduodenal fistula successfully treated with endovascular repair. Clin Case Rep 2021; 9:1039-1040. [PMID: 33598297 PMCID: PMC7869376 DOI: 10.1002/ccr3.3641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022] Open
Abstract
Aortoduodenal fistula is a rare cause of life-threatening upper gastrointestinal bleeding. Accurate diagnosis is essential to initiate definitive treatment because endoscopic hemostasis, which is the usual initial intervention for upper gastrointestinal bleeding, may be ineffective. This case underscores timely intervention using endovascular treatment for achieving hemostasis in aortoduodenal fistula.
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Affiliation(s)
- Junya Fuchigami
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Naoaki Shibata
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Takafumi Yonemitsu
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Kentaro Ueda
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Seiya Kato
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
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21
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Iatrogenic sigmoid perforation by vascular prosthesis during aortobifemoral bypass. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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22
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Gaines S, Babrowski TA, Skelly C, Milner R. Unique endovascular repair of an aortic pseudoaneurysm after staged approach for an aortoduodenal fistula. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:612-613. [PMID: 33163743 PMCID: PMC7599372 DOI: 10.1016/j.jvscit.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sara Gaines
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Trissa A Babrowski
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Christopher Skelly
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Ross Milner
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill
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Nagrani Chellaram S, Martínez Chamorro E, Borruel Nacenta S, Ibáñez Sanz L, Alcalá-Galiano A. Aortoenteric fistulas: Spectrum of MDCT findings. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aortoenteric fistulas: spectrum of MDCT findings. RADIOLOGIA 2020; 62:280-291. [PMID: 32245628 DOI: 10.1016/j.rx.2020.01.010] [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: 10/17/2019] [Revised: 01/01/2020] [Accepted: 01/30/2020] [Indexed: 11/23/2022]
Abstract
An aortoenteric fistula is an abnormal communication between the aorta and the gastrointestinal tract wall. The high mortality associated with this rare entity means it requires early accurate diagnosis. Aortoenteric fistulas are classified as primary when they develop on a native aorta that has not undergone an intervention and as secondary when they develop after vascular repair surgery. All radiologists need to be able to recognize the direct and indirect signs that might suggest the presence of an aortoenteric fistula. This article reviews the types of aortoenteric fistulas and their clinical and pathophysiological correlation, as well as the diagnostic algorithm, illustrating the most characteristic findings on multidetector computed tomography.
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Nguyen CL, Lindsay A, McLachlan R, Islam S, Qasabian R, Loa J. Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm. ANZ J Surg 2020; 90:2374-2376. [DOI: 10.1111/ans.15773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Chu Luan Nguyen
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
- Surgery Department The University of Sydney Sydney New South Wales Australia
| | - Andrew Lindsay
- Surgery Department The University of Sydney Sydney New South Wales Australia
| | - Rohan McLachlan
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
- Surgery Department University of New South Wales Sydney New South Wales Australia
| | - Samiul Islam
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Raffi Qasabian
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Jacky Loa
- Vascular Surgery Department Royal Prince Alfred Hospital Sydney New South Wales Australia
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