Primary Aortoenteric Fistulas Research Articles

Fatal gastrointestinal haemorrhage due to coexisting primary aorto-enteric and aorto-colic fistulae. Complicating untreated atheromatous abdominal aortic aneurysm

We report a case of aorto-enteric and aorto-colonic fistulae in a 73 year old man with no previous abdominal surgery which resulted in massive gastrointestinal haemorrhage and death and was undiagnosed despite several hospital admissions and endoscopic examinations. This case serves to highlight an extremely rare but fatal condition, which is potentially treatable, if an early diagnosis is made.

Primary Aortoenteric Fistula Secondary to Ulcerative Atherosclerosis

Aortoenteric fistulae after replacement surgery of the aorta is a well-described phenom enon. Fewer than 200 cases of primary aortoenteric fistulae have, however, been reported. The vast majority of these reveal aortic or gastrointestinal pathology as etiolo gies. The authors report on the very rare occurrence of primary aortoenteric fistula caused by ulcerative atherosclerosis in the absence of aortic aneurysm. The index of suspicion in patients with gastrointestinal bleeding of unknown etiology must be high to accurately diagnose an aortoenteric fistula. With aggressive testing and early laparotomy if indicated, the diagnosis of aortoenteric fistula can be ascertained and surgical correction can be accomplished.

Primary Aortoenteric Fistulas: A Case Report

Primary aortoenteric fistulas are rare vascular entities. Their recognition involves astute clinical observation. Diagnostic testing is frequently nonconfirmatory and usually impedes urgently needed operative intervention. We present a case of primary aortoenteric fistula and emphasize the necessity for immediate surgical evaluation.

Computed tomography diagnosis of primary aorto-enteric fistula

Primary aorto-enteric fistulae are rare. Preoperative diagnosis is important but is difficult and cannot usually be confirmed by upper gastrointestinal series, aortography and endoscopy. Computed tomography demonstrating an abdominal aortic aneurysm with air bubbles in its wall and “soft tissue” mass posteriorly should raise the possibility of penetration of the aneurysm into the lumen of the bowel and related consequences (hematoma, sepsis, infected operating field).

Aorto-Enteric Fistulas

The authors report a series of 10 patients who presented with 4 primary aorto-enteric fistulas (AEFs) and 8 secondary AEFs. Gastrointestinal bleeding is the main feature of this serious complication. The diagnosis is difficult; no single procedure: endoscopy, angiography, CAT scan, or upper gastrointestinal film series is regularly diagnostic for AEF. Acute massive exsanguination needs urgent explorative xyphopubic midline laparotomy without preoperative work- up. The surgical treatment consists of endoaneurysmorraphy or graft prosthesis resection without "in situ" vascular reconstruction. The extraanatomic bypass permits the revascularization of the lower limbs. In this series, the prognosis appeared to be poor. The mortality rate with primary AEF was 50%, and the morbidity consisted, after "in situ" reconstruction, of early or late secondary AEF. In secondary AEF, the mortality rate after extraanatomic reconstruction with graft excision was 62%. The main complications were infection, fistuliza tion, and hemorrhage.

A CASE OF PRIMARY AORTODUODENAL FISTULA

A case of primary aortoduodenal fistula caused by a very small aortic aneurysm is reported and the 22 primary aortoenteric fistulas in the Japanese literature were analyzed. The patient was a 75-year-old male with a previous history of gastrectomy. He was admitted to our hospital for massive hematemesis and melena. After admission, episodes of massive gastrointestinal hemorrhage and shock recurred. However neither repeated endoscopy nor abdominal angiography could reveal the sourse of bleeding. Explorative laparotomy was carried out, but no obvious bleeding source was identified and the remnant of stomach was resected. Postoperatively, the episodes of gastrointestinal hemorrhage continued and he died on the 9th postoperative day. At autopsy, a saccular aortic aneurysm measuring 1.0 × 0.8 cm just proximal to the orfice of the inferior mesenteric artery was found. This aneurysm perforated into the third portion of the duodenum and formed an aortoduodenal fistula. Histologically, it was considered an atherosclerotic aneurysm. In the Japanese literature, 22 cases of primary aortoenteric fistula are reported. However there were no patients with a small aortic aneurysm as in our case.