Upper gastrointestinal bleeding is bleeding that originates proximal to the ligament of treitz. Aortoenteric fistula aef is a condition where there is an abnormal connection between the aorta and a loop of bowel. Right axial cect in a 70yearold man presenting with fever and hematemesis months after abdominal aortic aneurysm aaa repair shows the native, calcified aortic wall wrapped around a synthetic graft. An aortoduodenal fistula is a potentially lethal complication after transperitoneal open repair of an abdominal aortic aneurysm. Allografts offer a high resistance to infection1, 2 1. An aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding. During the last ten years, 14 patients with proven aortoenteric fistulas were admitted to the greenville hospital system, a community system of 1200 beds in four units serving a county of 250,000 residents. These patients often present with a herald bleed, followed by massive gastrointestinal hemorrhage. This patient who had previous aorta repair presented with massive gastrointestinal bleed.
It is most often the result of primary compression of the aorta eg, abdominal aortic aneurysm against, or erosion of an aortic prosthetic graft into, the. Management of aortoenteric fistula advances in surgery. During an 11year period ending in december 1991, 36 patients with aortoenteric fistulas were assessed and treated. Aortoenteric fistula aef is an uncommon but lifethreatening condition. Although the reported incidence of aef is low, immediate recognition and management is essential for the patients survival. Patients with an aef are commonly encountered as a medical emergency associated with acute gi bleeding.
Case report successful treatment of secondary aortoenteric. Aortoenteric fistula travis 1987 journal of medical. Editorial comment on aortoenteric fistula causing massive bleeding. An aortoenteric fistula is a connection between the aorta and the intestines, stomach, or esophageus. However, evidence regarding aortoenteric fistula is scant in the existing literature, largely based on singlecentre case reportsto date 53 aortoenteric fistula patients have been documented in 20 case reports and seven small series. Early diagnosis can be achieved by computed tomography and endoscopy exploration. Editorial comment on aortoenteric fistula causing massive. Aortoenteric fistula as a complication of open reconstruction. American university of integrative sciences school of medicine faculty advisor. Diverse presentation of secondary aortoenteric fistulae. There can be significant blood loss into the intestines resulting in bloody stool and death. Aortoenteric fistulas are serious and lifethreatening complications of aortic surgery. Request pdf diagnosis and management of aortoenteric fistulas development of an aortoenteric fistula aef is a devastating and lifethreatening condition, which is as difficult to diagnose as.
Secondary aortoenteric fistulation is a well known, infrequent but serious complication after open aortoiliac reconstructive surgery. Aefs are classi ed as primary or secondary depending on their etiology. Inflammatory stranding and gas between abdominal aorta and 3rd part of duodenum following aneurysm repair. Aortoenteric fistula video journal and encyclopedia of gi. Aortoenteric fistula aef is an uncommon and emergency clinical condition of intraabdominal bleeding.
Secondary aortoenteric fistula saf is an uncommon but very important complication of abdominal aortic reconstruction. Presentations were diverse, including hematemesis, coffee. The prerequisite is close contact between the reconstruction and a part of the bowel, the cause being pressure and bowel erosion from an anastomotic aneurysm, the anastomotic suture line, or the graft itself. Aortoenteric ffistulaistula joyce au suny downstate grand rounds november 1, 2012. Four cases of aortoenteric and paraprostheticenteric fistulizations are presented. Files are available under licenses specified on their description page. The typical presentation is a patient with gastrointestinal bleeding acute or chronic and an abdominal aortic graft, often with symptoms of infection.
Aortoenteric fistula aortoenteric fistula aef is a rare, lifethreatening disease process. Aortoenteric fistula definition of aortoenteric fistula. Aef remain rare, despite the innumerable episodes of bacteremia that people experience in their lifetime. Similarly, in the chest, when a large thoracic aortic aneurysm compresses the esophagus.
The pathogenesis of aef formation after endovascular abdominal aortic repair is related to mechanical failure of the stentgraft, to. Can form fistula anytime within life of aaa graft repair higher risk with recent graft placement. Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of aef after open aortic repair. Acp michigan chapter scientific meeting 2017 medical student. Risk factors for upper gi bleeding include medications aspirin, steroids, anticoagulation, ethanol abuse, and aortoenteric fistula after aortic graft placement. Aortoenteric ffistulaistula suny downstate medical center.
Diagnosis and management of aortoenteric fistulas request pdf. Look for a new 5 minute video every monday on the blog. Although the ct did not show contrast in the fistula tract and bowel, the presence of gas within the aorta and the contact of a small bowel loop at adjacent location made the diagnosis highly likely. Nov 16, 2016 aortoenteric fistula left graphic shows a fistula between the transverse duodenum and aorta at the site of the graftaortic suture line. Usually due to erosion of an atherosclerotic aneurysm into the adherent bowel usually duodenum. Maefisto study highlights the characteristics of late. Abnormal communication between aorta and gastrointestinal tract. Secondary aortoenteric fistula after placement of aortic stent grafts has also been described. Particular emphasis is placed on the distinct clinicopathologic characteristics of these two types of graftenteric fistula which, if unrecognized, result in an almost invariably fatal outcome. Successful surgical treatment of aortoenteric fistula. The first patient, a fiftysixyearold woman, underwent a right hemicolectomy for carcinoma in 1986 and presented three years later with massive hematemesis and hematochezia. The authors report 2 cases of primary aortoenteric fistula and discuss a number of interesting features demonstrated by them.
A primary aortoenteric fistula forms when a large abdominal aortic aneurysm closely abuts bowel loops, usually the 3 rd or 4 th parts of the duodenum. Incidence of primary aortoenteric fistulas is estimated to be about 0. The experience obtained is tabulated, and illustrative case reports are used to emphasize the diagnostic and treatment problems inherent in this group of patients. Aortoenteric fistulae aef represent the most lethal subset of aortic infections. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding.
Aortoenteric fistula an overview sciencedirect topics. Treatment of the disease is early surgical intervention. Aortoenteric fistula allograft tissue most closely resembles the patients native tissue convenient. Technical challenges include scarring from the infection and often. It is rare, potentially fatal, and is difficult to diagnose and manage. Most commonly a complication of repair of abdominal aortic aneurysms. Aortoenteric fistula is a communication between the aorta and adjacent bowel.
Oct 31, 2015 posted in gi tagged aortoenteric, fistula, gi bleed, vascular post navigation. Patients presentation range from those with an occult anemia, to those with catastrophic gastrointestinal gi hemorrhage and sepsis. Oct 31, 2007 an aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding. Twentyfive patients 69% had previously undergone aortic reconstruction with dacron grafts, and 11 31 % had spontaneous aortoenteric fistulas. All structured data from the file and property namespaces is available under the creative commons cc0 license. Introduction aortoenteric stula aef is a rare and lifethreatening condition associated with diagnostic challenges. Aortoenteric fistula definition of aortoenteric fistula by. Of these complications, an aortoenteric fistula is considered a dramatic and lethal problem. Aef is defined as an abnormal connection between the aorta or aortoiliac tree and the gastrointestinal tract.