Case Report: Duodenoscopy diagnosis of a secondary aorto-duodenal fistula: A case report and review of literature.

Hanen Elloumi,Wissem Triki,Imed Cheikh,Imen Ganzoui,Makrem Ben Hmida,Ilhem Mchirgui,Sonia Ben Hamida,Bilel Derbel,Ben Mrad Melek

doi:10.12688/f1000research.54599.1

Hanen Elloumi, Wissem Triki + Show 7 more

Open Access

https://doi.org/10.12688/f1000research.54599.1

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Abstract

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

Highlights

Secondary aorto-enteric fistula (SAEF) is an abnormal communication between a prosthetic graft and the gastrointestinal tract that happens after an abdominal infrarenal aortic graft implant to treat aortic aneurysm or occlusive disease.[1]
We report in this paper a case of secondary aorto-duodenal fistula revealed by a severe anemia and confirmed with exceptional duodenoscopy images showing the Dacron prothesis protruding into the lumen of the duodenum
The accuracy of EGD is limited beyond the second portion of the duodenum while most of SAEFs occur in the third and fourth parts of the duodenum. This explains the scarcity of reports in the medical literature that have been able to highlight by duodenoscopy this aortoduodenal fistula.[3,15,16,17,18,19]

Summary

Introduction

Secondary aorto-enteric fistula (SAEF) is an abnormal communication between a prosthetic graft and the gastrointestinal tract that happens after an abdominal infrarenal aortic graft implant to treat aortic aneurysm or occlusive disease.[1] SAEF is a rare life-threatening complication with an incidence lower than 2% after aortic prosthetic reconstruction.[1] Its diagnosis is sometimes challenging and delayed because of a lack of specific signs.[2] Upper endoscopy should be done primarily to eliminate another cause of digestive bleeding In rare cases it can confirm the diagnosis by showing the protrusion of the aortic graft in the distal duodenum.[3] We report in this paper a case of secondary aorto-duodenal fistula revealed by a severe anemia and confirmed with exceptional duodenoscopy images showing the Dacron prothesis protruding into the lumen of the duodenum. In order to better elucidate this finding, a duodenoscopy was performed, demonstrating a large

Findings

Discussion

Conclusion