Primary aortoenteric fistula related to septic aortitis

Abstract

A 65-year-old woman was admitted with Salmonella bacteremia that evolved to septic aortitis. An aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. In the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. The aorta was sutured and an axillofemoral bypass was carried out. In the intensive care unit, the patient had a cardiac arrest that evolved to death.

Primary aortoenteric fistula

“…Computed tomography (CT) was performed in 49 patients, usually following a negative finding on endoscopy. In 30 of these patients CT images were interpreted as proof or suggestive of a PAEF (for example, air within aortic wall24, 32, 47, 65, 66 ( Fig. ), focal bowel wall thickening, disruption of aortic fat cover12, 27, 34, 45, 59 ( Fig.…”

“…One patient was treated only by a coiling procedure; he tolerated this well and was alive 67 months later28. Disconnection of the PAEF followed by extra‐anatomic bypass was performed in five additional patients, of whom two died32, 42.…”

Molecular diagnosis of nonaneurysmal infectious aortitis

“…If untreated, it will likely progress to a mycotic aneurysm with possible rupture. 1,2 There are only a few reported cases of infectious aortitis in the absence of aneurysm or rupture, 3,4 and the incidence is largely unknown. In those reports, the patients were elderly and suffered from atherosclerosis and illustrate the difficulty in making this diagnosis, as the initial clinical presentation is often vague and nonspecific.…”

Acute Infectious Pseudoaneurysm of the Descending Thoracic Aorta and Review of Infectious Aortitis

“…Microbial aortitis occurs in the minority of cases and refers to the disease state when a normal aorta undergoes aneurysmal or pseudoaneurysmal formation in the presence of vessel wall infection, leading to wall degeneration. 4,5 The thoracic aorta is a less-frequent site (30%) than the abdominal aorta for the formation of spontaneous mycotic aneurysms. 6 Secondary mycotic aneurysms more commonly occur in this anatomic segment following cardiac or thoracic aortic interventions and at least 50% of the pseudoaneurysms that develop in this area are associated with infection.…”