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Jahanshahi F, Naderi D, Khaleghian M, Sarafi M, Ahmadi V, Saberi A. Primary aortoduodenal fistula: As a first presentation of brucellosis; a case report. Int J Surg Case Rep 2024; 118:109609. [PMID: 38653169 PMCID: PMC11063533 DOI: 10.1016/j.ijscr.2024.109609] [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: 01/19/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The etiologies of primary aortoenteric fistula include aneurysm (most common), foreign body, tumor, radiation therapy, and infection (e.g., tuberculosis, syphilis). Brucellosis is a rare cause of primary aortoenteric fistula. PRESENTATION OF CASE In this study, we reported the case ofa 55-years-old male with an aortoenteric fistula and a positive brucellosis test. DISCUSSION In regions where brucellosis is endemic, the coexistence of aortitis and aneurysm should prompt consideration of brucella infection as a relatively uncommon cause of aortoenteric fistula. CONCLUSION While aortitis due to brucellosis is rare, it can lead to life-threatening manifestations such as aortoduodenal fistula. Therefore, we recommend the use of Wright, Coombs Wright, and 2ME tests in similar cases.
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Affiliation(s)
| | - Delaram Naderi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khaleghian
- Department of General Surgery, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Sarafi
- Department of General Surgery, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Ahmadi
- Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saberi
- Department of General Surgery, School of Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.
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Kuo CL, Chen CF, Su WK, Yang RH, Chang YH. Rare finding of primary aortoduodenal fistula on single-photon emission computed tomography/computed tomography of gastrointestinal bleeding: A case report. World J Clin Cases 2023; 11:7162-7169. [PMID: 37946757 PMCID: PMC10631403 DOI: 10.12998/wjcc.v11.i29.7162] [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: 06/27/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Primary aortoduodenal fistula is a rare cause of gastrointestinal (GI) bleeding consisting of abnormal channels between the aorta and GI tract without previous vascular intervention that results in massive intraluminal hemorrhage. CASE SUMMARY A 67-year-old man was hospitalized for coffee ground vomiting, tarry stools, and colic abdominal pain. He was repeatedly admitted for active GI bleeding and hypovolemic shock. Intermittent and spontaneously stopped bleeders were undetectable on multiple GI endoscopy, angiography, computed tomography angiography (CTA), capsule endoscopy, and 99mTc-labeled red blood cell (RBC) scans. The patient received supportive treatment and was discharged without signs of rebleeding. Thereafter, he was re-admitted for bleeder identification. Repeated CTA after a bleed revealed a small aortic aneurysm at the renal level contacting the fourth portion of the duodenum. A 99mTc-labeled RBC single-photon emission CT (SPECT)/CT scan performed during bleeding symptoms revealed active bleeding at the duodenal level. According to his clinical symptoms (intermittent massive GI bleeding with hypovolemic shock, dizziness, dark red stool, and bloody vomitus) and the abdominal CTA and 99mTc-labeled RBC SPECT/CT results, we suspected a small aneurysm and an aortoduodenal fistula. Subsequent duodenal excision and duodenojejunal anastomosis were performed. A 7-mm saccular aneurysm arising from the anterior wall of the abdominal aorta near the left renal artery was identified. Percutaneous intravascular stenting of the abdominal aorta was performed and his symptoms improved. CONCLUSION Our findings suggest that 99mTc-labeled RBC SPECT/CT scanning can aid the diagnosis of a rare cause of active GI bleeding.
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Affiliation(s)
- Chun-Liang Kuo
- Department of Nuclear Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Ching-Fu Chen
- Department of Gastroenterology, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Wen-Ko Su
- Department of Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Rong-Hsin Yang
- Department of Nuclear Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
| | - Yu-Hong Chang
- Department of Nuclear Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu 30071, Taiwan
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A case report of primary aortoduodenal fistula: A forgotten cause of gastrointestinal bleeding. Radiol Case Rep 2023; 18:1556-1559. [PMID: 36815143 PMCID: PMC9939541 DOI: 10.1016/j.radcr.2022.12.064] [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: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
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.
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Jaber F, Alsakarneh S, Sanders K, Ibrahim A, Ghoz H, Clarkston W, McMahon C. It Is Not Always Diverticular Bleeding: Fatal Subtle Primary Aorto-Duodenal Fistula Associated With Abdominal Aortic Aneurysm. Cureus 2023; 15:e34461. [PMID: 36874685 PMCID: PMC9980874 DOI: 10.7759/cureus.34461] [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] [Accepted: 01/31/2023] [Indexed: 02/03/2023] Open
Abstract
Primary aorto-duodenal fistula (PADF) is a connection between the aorta and duodenum without prior aortic surgery. We present a case of an 80-year-old female who presented with hematochezia. She was vitally stable but later developed a large episode of hematemesis followed by cardiac arrest. A computed tomography angiogram (CTA) chest scan showed an abdominal aortic aneurysm (AAA) with no leakage or rupture. Esophagogastroduodenoscopy (EGD) demonstrated blood in the stomach and duodenum, but no source was identified. Tagged RBC scan showed massive hemorrhage in the stomach and proximal small bowel. Further review of the CT images identified a subtle PADF. The patient underwent endovascular aneurysm repair but died shortly after. Physicians should maintain a high awareness of PADF, particularly in elderly patients with obscure gastrointestinal bleeding with or without known AAA. Herald bleeding in the setting of an aortic aneurysm should raise suspicion for PADF even in the absence of extravasation on CTA.
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Affiliation(s)
- Fouad Jaber
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Saqr Alsakarneh
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Kimberly Sanders
- Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, USA
| | - Ali Ibrahim
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Hassan Ghoz
- Gastroenterology, University of Missouri-Kansas City, Kansas City, USA
| | - Wendell Clarkston
- Gastroenterology and Hepatology, University of Missouri-Kansas City, Kansas City, USA
| | - Charles McMahon
- Gastroenterology and Hepatology, Mid-America Gastro-Intestinal Consultants, Kansas City, USA
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Feliciano DV, Schwaitzberg SD, DuBose JJ. Aortoduodenal fistula after repair of a stab injury to the abdominal aorta. Trauma Surg Acute Care Open 2022; 7:e000882. [PMID: 35128070 PMCID: PMC8785199 DOI: 10.1136/tsaco-2022-000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- David V Feliciano
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Joseph J DuBose
- Department of Surgery, Dell Seton Medical Center at The University of Texas, Austin, Texas, USA
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Vacca G, De Berardinis C, Cappabianca S, Vanzulli A. A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it. BJR Case Rep 2022; 8:20210143. [PMID: 35136648 PMCID: PMC8803215 DOI: 10.1259/bjrcr.20210143] [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: 07/25/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Although gastrointestinal hemorrhage from aorto-enteric fistulae (AEF) secondary to previous aortic grafts are well known, a primary aorto-enteric fistula (PAEF) without aortic aneurysm is an extremely rare event resulting in poor prognosis and outcome. PAEF is a rare cause of gastro-intestinal (GI) bleeding that radiologists should consider because often its presence is not easily guessed by clinical features. It is difficult to detect at CT examination therefore PAEF might be not diagnosed until a laparotomy. We report a case of a 74-year-old Italian male who presented to our Emergency Department (ED) with brightly red rectal bleeding that occurred from some hours and a pre-syncopal episode. There was no history of analgesic abuse, peptic ulceration, alcohol excess, and weight loss. Standard resuscitation was commenced with the hope that common sources of bleeding such as peptic ulcers or varices would eventually be discovered by endoscopy and treated definitely. An upper GI endoscopy showed brightly red blood in the stomach and in the first portions of duodenum, but no source of active bleeding was found. Diagnosis of PAEF was made by CT and after confirmed during surgical intervention. Both the duodenum and the aorta were successfully repaired by direct suture and synthetic graft replacement, respectively. Diagnosis of primary aortic duodenal fistula (ADF) has been very difficult in this case especially because our patient did not have abdominal aortic aneurism (AAA) history confirmed by CT examination. Radiologist should remember that upper GI bleeding could however be determined by primary ADF also if atherosclerotic damage is severe as in this case. A technically good and complete exam is mandatory to achieve this rare and complex diagnosis. Particularly, an ultra-tardive acquisition phase (5 min after contrast administration) could be helpful to suspect the presence of PADF: the appearance of contrast into the duodenal lumen is an evocative sign useful to increase clinical and radiological suspicious of ADF. Gl bleeding should be assumed to be caused from a PAEF unless another source can be identified without delay. A timely and accurate diagnosis of primary AEF may be challenging due to insidious episodes of GI bleeding, which are frequently under diagnosed until the occurrence of massive hemorrhage.
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Affiliation(s)
- Giovanna Vacca
- Department of University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | | | | | - Angelo Vanzulli
- Department of Radiology, University “La Statale” of Milan, Milan, Italy
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Fatal Aortoduodenal Fistula Caused by a Ruptured Abdominal Aortic Aneurysm - a Case Report. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
ABSTRACT
Introduction: Ruptured abdominal aortic aneurysm (AAA) has a high mortality, even when the patients reach the hospital in time and the intervention is expeditious. Case presentation: We present the case of a 66-year-old male patient, with a known history of AAA, presenting to the emergency room in a state of hypovolemic shock due to massive bleeding in the upper and lower gastrointestinal tract and acute abdominal pain, which presented an abrupt onset one hour before presentation. The computed tomography angiography identified an aortoduodenal fistula with a trajectory toward the D3 segment of the duodenum, as well as a common iliac artery occlusion and extensive atherosclerotic stigmas. The patient was rushed to the operation room where he was resuscitated with intravenous fluids, two units of packed red blood cells, and hemostatic agents. The bleeding was stopped by clamping the aorta above the aneurysm. The duodenum was sutured, and the aorta was reconstructed with an aortobifemoral graft. Unfortunately, even though intensive care procedures continued for a few hours after surgery, all therapeutic efforts failed and the patient had succumbed.
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St. Stoyanov G, Dzhenkov D, Petkova L. Primary aortoduodenal fistula: a rare cause of massive gastrointestinal hemorrhage. Autops Case Rep 2021; 11:e2021301. [PMID: 34458170 PMCID: PMC8387084 DOI: 10.4322/acr.2021.301] [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: 05/16/2021] [Accepted: 06/04/2021] [Indexed: 01/16/2023]
Abstract
Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.
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Affiliation(s)
- George St. Stoyanov
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Deyan Dzhenkov
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
| | - Lilyana Petkova
- Medical University of Varna “Prof. Dr. Paraskev Stoyanov”, Faculty of Medicine, Department of General and Clinical Pathology, Forensic Medicine and Deontology, Varna, Bulgaria
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Gulati A, Kapoor H, Donuru A, Gala K, Parekh M. Aortic Fistulas: Pathophysiologic Features, Imaging Findings, and Diagnostic Pitfalls. Radiographics 2021; 41:1335-1351. [PMID: 34328814 DOI: 10.1148/rg.2021210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fistulas between the aorta and surrounding organs are extremely rare but can be fatal if they are not identified and treated promptly. Most of these fistulas are associated with a history of trauma or vascular intervention. However, spontaneous aortic fistulas (AoFs) can develop in patients with weakened vasculature, which can be due to advanced atherosclerotic disease, collagen-vascular disease, vasculitides, and/or hematogenous infections. The clinical features of AoFs are often nonspecific, with patients presenting with bleeding manifestations, back or abdominal pain, fever, and shock. Confirmation with invasive endoscopy is often impractical in the acute setting. Imaging plays an important role in the management of AoFs, and multiphasic multidetector CT angiography is the initial imaging examination of choice. Obvious signs of AoF include intravenous contrast material extravasation into the fistulizing hollow organ, tract visualization, and aortic graft migration into the adjacent structure. However, nonspecific indirect signs such as loss of fat planes and ectopic foci of gas are seen more commonly. These indirect signs can be confused with other entities such as infection and postoperative changes. Management may involve complex and staged surgical procedures, depending on the patient's clinical status, site of the fistula, presence of infection, and anticipated tissue friability. As endovascular interventions become more common, radiologists will need to have a high index of suspicion for this entity in patients who have a history of aneurysms, vascular repair, or trauma and present with bleeding. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. ©RSNA, 2021.
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Affiliation(s)
- Aishwarya Gulati
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Harit Kapoor
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Achala Donuru
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Kunal Gala
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
| | - Maansi Parekh
- From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19107 (A.G., A.D., M.P.); Department of Radiology, University of Kentucky Medical Center, Lexington, Ky (H.K.); and Division of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha University, Mumbai, India (K.G.)
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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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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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Reinecke J, Amanzada A, Elger F, Ghadimi M, Neesse A. A rare cause of upper gastrointestinal bleeding from a submucosal tumor. Endosc Ultrasound 2021; 10:75-76. [PMID: 33402553 PMCID: PMC7980693 DOI: 10.4103/eus.eus_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Johanna Reinecke
- Department of Gastroenterology and Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Ahmad Amanzada
- Department of Gastroenterology and Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
| | - Florian Elger
- Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Ghadimi
- Department of General, Visceral, and Pediatric Surgery, University Medical Center Goettingen, Goettingen, Germany
| | - Albrecht Neesse
- Department of Gastroenterology and Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
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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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Makimoto S, Takami T, Shintani H, Kataoka N, Yamaguchi T, Tomita M, Shono Y, Kuroyanagi S. Cases of two patients with aortoduodenal fistula who underwent emergency operation. Int J Surg Case Rep 2020; 69:87-91. [PMID: 32305028 PMCID: PMC7163285 DOI: 10.1016/j.ijscr.2020.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 01/11/2023] Open
Abstract
Aortoduodenal fistula is a rare cause of gastrointestinal bleeding. However, it is life threatening. Diagnosis requires a high level of clinical suspicion, and surgery can offer the best chance of survival. Primary aortoduodenal fistula is often caused by aortic aneurysm without any previous vascular intervention. Secondary aortoduodenal fistula occurs after surgical treatment for abdominal aortic aneurysm.
Introduction Aortoduodenal fistula (ADF) is a rare but life-threating condition, and it is an important cause of massive gastrointestinal bleeding. Primary ADF often occurs as a result of aortic aneurysm, and secondary ADF develops after the placement of aortic prosthetic graft. Presentation of cases Case 1: A 64-year-old man with hematemesis was transferred to our hospital. The patient was diagnosed with primary ADF. Thus, we performed prosthetic graft replacement for an aortic aneurysm, and suturing of the duodenal fistula and duodenojejunal side-to-side anastomosis were performed. He was then discharged on the 35th postoperative day. After 2 years and 10 months, he died of other diseases. Case 2: A 76-year-old man with a history of abdominal aortic aneurysm repair with a prosthetic graft 5 years back who presented with hematemesis and melena was transferred to our hospital. The patient was diagnosed with secondary ADF, and an emergency endovascular aneurysm repair (EVAR) and suturing of the duodenal fistula were perfomed. He was transferred for rehabilitation purposes on the 108th postoperative day but eventually died of pneumonia 6 months after surgery. Discussion ADF is associated with high mortality. Initial bleeding is usually minor and often intermittent. However, it leads to severe bleeding and hemorrhagic shock. EVAR is preferred over open surgery because it can be performed faster and is less invasive. Recently, in case of hemorrhagic shock, EVAR is used as first-line treatment. Conclusion Accurate diagnosis and immediate treatment are important for the survival of patients with ADF.
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Affiliation(s)
- Shinichiro Makimoto
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan.
| | - Tomoya Takami
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Naoki Kataoka
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Tomoyuki Yamaguchi
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Masafumi Tomita
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Yoshiharu Shono
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
| | - Satoshi Kuroyanagi
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan
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Petrunić M, Meštrović T, Halužan D, Perkov D, Golemović M, Golubić – Ćepulić B. Recurrent Aortic Infections Due to Unrecognized Aorto-Enteric Fistula. Ann Vasc Surg 2020; 63:455.e11-455.e15. [DOI: 10.1016/j.avsg.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022]
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Zhan Y, Xu Z. Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation: A case report and literature review. Medicine (Baltimore) 2019; 98:e18303. [PMID: 31860979 PMCID: PMC6940160 DOI: 10.1097/md.0000000000018303] [Citation(s) in RCA: 5] [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: 12/19/2022] Open
Abstract
RATIONALE Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
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Jolobe OMP. The Association of Peptic Ulcer Disease and Abdominal Aortic Aneurysm. Am J Med 2019; 132:e724. [PMID: 31128866 DOI: 10.1016/j.amjmed.2019.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
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18
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Jolobe OMP. Evaluation of abdominal aortic aneurysm in patients with nonvariceal upper gastrointestinal hemorrhage. Am J Emerg Med 2018; 37:1204-1206. [PMID: 30415980 DOI: 10.1016/j.ajem.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, United Kingdom of Great Britain and Northern Ireland.
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