A rare and forgotten diagnosis of gastrointestinal bleeding: primary aortoduodenal fistula

A case report of primary aortoduodenal fistula: A forgotten cause of gastrointestinal bleeding

Aortoenteric fistula is one of the uncommon emergencies and is challenging to navigate for diagnostic testing. Here, we present a clinical case of an aortoduodenal fistula with primary etiology. A 73-year-old female patient with a history of hypertension was admitted to the hospital because of a 1-day history of melena. Ultrasound showed an abdominal aortic aneurysm sized (33 × 46) mm and a hematoma on the wall of the aorta. The patient underwent a gastrointestinal endoscopy with no bleeding point detected. However, the patient suddenly fell into a hemorrhagic shock on day 3 of admission. We rapidly performed fluid resuscitation, blood transfusion, a second gastrointestinal endoscopy, and a computed tomography scan of the abdomen with contrast injection that revealed a fistula from the abdominal aorta into the second segment of the duodenum. The patient was indicated for urgent endovascular aortic repair. Although this technique was successful with 3 abdominal aortic stents, the patient died due to multiorgan failure. Delayed diagnosis is the root cause of primary aortoduodenal fistula treatment failure, so it is important for clinicians to keep aortoduodenal fistula in mind as a possible cause of gastrointestinal bleeding in any patient.

Primary aortoenteric fistula: is endovascular repair the prime option? A review of the literature

Primary aortoenteric fistula (PAEF) is a rare entity that demands high clinical suspicion and efficient management in a limited time. The evolution of interventional radiology established endovascular repair (EVAR) as an attractive option. The English literature was searched using the PubMed database with the terms "primary aortoenteric fistula", "primary aortoduodenal fistula" or "aortoduodenal fistula", and "endovascular repair" in different combinations. Studies and original articles that described the role and the outcomes of EVAR for primary aortoenteric fistula were included. Fourteen articles with a total of 15 patients with primary aortoenteric fistula who were managed with EVAR were included in our literature review. PAEF is a rare and lethal entity that everyone should be aware of. EVAR is a salvage option and a valuable weapon in our armamentarium. Is EVAR really a "bridge to surgery" or is it the birth pangs of a minimally invasive definite treatment of PAEF?

Aortoenteric and Enterocaval Fistulas Secondary to a Duodenal Erosion Caused by a Prosthetic Vascular Graft

Aortoenteric and enterocaval fistulas represent uncommon complications following vascular surgery. These typically occur secondary to intestinal wall erosion by the prosthetic grafts and materials, and it is associated with regional inflammation and infection. We herein present a patient who developed both of these rare complications caused by a polytetrafluroethylene inferior vena cava (IVC) graft a year after the resection of a rare metastatic Sertoli-Leydig retroperitoneal tumor and concomitant aortocaval reconstruction. The patient presented with herald gastrointestinal bleeding and gram-negative bacteremia; and a duodenotomy, graft removal followed by IVC ligation and repeat right aortoiliac reconstruction were performed. The patient recovered well and following the appropriate postoperative care he was discharged 6 days after surgery without any further vascular or gastrointestinal complications and with neoadyuvant chemotherapy.

Diagnosis and treatment of upper gastrointestinal bleeding caused by pseudoaneurysm rupture following radical gastrectomy

AIM: To explorer the clinical features of upper gastrointestinal bleeding caused by rupture of pseudoaneurysms involving celiac axis branches following radical gastrectomy and to discuss its diagnosis, treatment and prognosis.

METHODS: Two cases of upper gastrointestinal bleeding caused by rupture of pseudoaneurysms involving celiac axis branches following radical gastrectomy were treated at our hospital. The clinical features and treatment of this postoperative complication were investigated. A literature review of six such cases was performed to summarize the characteristics of the disease.

RESULTS: All 6 patients were male, and the mean time from surgery to bleeding was 30 d. Main symptoms include upper gastrointestinal bleeding and abdominal pain. Selective angiography could provide comprehensive diagnostic information. Interventional treatment and/or surgery were performed in all 6 cases, and the mortality rate was 66.7%.

CONCLUSION: The formation of an aortoenteric fistula between a pseudoaneurysm and the gastrointestinal tract may be the etiology of gastrointestinal bleeding. Total prognosis is poor. Selective angiography is the main diagnostic method. Prompt aggressive interventional treatment and surgical intervention are mandatory for survival. Postoperative treatments including reinforced anti-inflammatory and nutritional support are important for improving the cure rate.