Aortoenteric fistula: a diagnostic dilemma

Cassidy, Fiona; Kavanagh, Dara; Barry, Mary; Owens, A.; MacErlaine, Donal P.; Malone, Dermot E.

doi:10.1007/s00261-006-9062-7

Cited by 68 publications

(49 citation statements)

References 16 publications

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“…GI endoscopic evaluation often identifies the site of bleeding and allows directed urgent lifesaving therapy. However, the sensitivity of upper GI endoscopy in diagnosis of AEF has been reported to be only 50% (Wood et al, 2005;Hughes et al, 2007). What's worse, findings of gastritis or peptic ulcer other than AEF itself by GI endoscopy may be misleading and lead to a delayed diagnosis of AEF (Saers and Scheltinga, 2005;Mavioglu et al, 2005).…”

Section: Discussionmentioning

confidence: 96%

“…Signs such as perigraft ectopic gas and intravasation of contrast into the bowel lumen or perigraft space favor the diagnosis of AEF (Perks et al, 2004). A study has compared CT scan findings with operative results and concluded that this examination had a sensitivity of 94% and a specificity of 85% in detecting AEF (Hughes et al, 2007). Multidetector CT, providing excellent image quality and enabling volume-rendered image reconstruction, is particularly useful for the diagnosis of AEF when the patient's bleeding rate is slow and when detection of the proximal part of the fistula tract might be enough for diagnosis (Ödemiş et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Zhou

Shen

et al. 2009

J. Zhejiang Univ. Sci. B

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Abstract:Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum, but a prolonged shock led to the patient's death. In summary, early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Zhou

Shen

et al. 2009

J. Zhejiang Univ. Sci. B

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“…Historically, diagnosis of aortoenteric fistula has been made post-mortem in half of patients because of these challenges in diagnosis. Contrastenhanced CT scanning is now the diagnostic modality of choice in this setting because of its superior sensitivity (80-90%) and specificity (100%) [5].…”

Section: Discussionmentioning

confidence: 99%

Cancer-Associated Aorto-Enteric Fistula

et al. 2011

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A 46 year-old woman presented to the emergency department with hematemesis associated with syncope. The patient's only complaint was severe and diffuse abdominal pain that prohibited her from providing further history. According to her family, she had melena while at home and was found in the bathroom unconscious. The patient spontaneously regained consciousness before arrival of the emergency medical services. She denied any NSAID or aspirin use, although she was on daily enoxaparin for deep vein thrombosis that was extending from her inferior vena cava to her femoral vein. On her arrival at the emergency department, gastroenterology, general surgery, interventional radiology, and intensive care unit teams were consulted about the emergency.The patient's prior medical history started with diagnosis with stage IIIC (T3N2M0) sigmoid adenocarcinoma two years previously, in the setting of rectal bleeding. She underwent a left hemi-colectomy, partial cystectomy, and left ovarian and left fallopian tube resection. She subsequently received adjuvant oxaliplatin, capcitabine, and bevacizumab. She was also treated with radiation therapy of the peri-aortic lymph nodes because, at the time of surgery, four out of 21 lymph nodes were positive. Four months before admission, the patient presented with a small bowel obstruction resulting in operative intervention that included lysis of adhesions, partial resection of the ileum with side-to-side entero-enterostomy, cystoscopy with left ureteral catheter, and lymph node dissection. The histology demonstrated involvement of the retroperitoneal and peri-aortic lymph nodes and ileal serosa. Consequently, she was treated with irinotecan and bevacizumab.During the four weeks before this most recent admission, she had been hospitalized several times, most recently four days before admission, with nausea, vomiting, and abdominal pain that were attributed to gastroparesis secondary to narcotics, with chemotherapy and paraneoplastic phenomena considered as additional possible contributing factors. Specifically, the patient's generalized abdominal pain was attributed to her metastatic disease and gastroparesis.The patient did not have any other pertinent medical, social, or family history. Her medications included enoxaparin, dilaudid, pantoprazole, desipramine, compazine, gabapentin, lorazepam, lomotil, ondansetron, metoclopramide, and fentanyl patch.She had several gastrointestinal studies leading to her most recent presentation. A colonoscopy performed one year before this admission did not demonstrate any abnormalities. A gastric emptying study performed two months before admission showed 52% retention at 4 h (normal \10%). During that same hospitalization, the patient had an upper endoscopy showing granular gastric mucosa with histology showing H. pylori-negative mild chronic gastritis. Two months before admission, a brain MRI scan did not reveal metastatic disease.On examination in the emergency department, the patient was afebrile, tachycardic (HR 139), hypotensive (89/62), tachypn...

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“…A negative scan in the presence a suggestive clinical picture does not rule out the diagnosis, but mandates further investigations [9]. Some authors recommend the omission of oral contrast with the abdominal CT scan in order to demonstrate contrast extravasation from the aorta into the bowel lumen [10].…”

Section: Discussionmentioning

confidence: 99%

A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease

Pace

Savino

Rasoini³

et al. 2010

Intern Emerg Med

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Case presentationDr. Del Pace: A 72-year-old man with history of coronary and peripheral artery disease was admitted to this hospital with fever, fatigue and loss of weight. He had hypertension, type 2 diabetes mellitus and hyperlipidemia. He suffered from an ischemic cardiomyopathy with a low ejection fraction (33%). Fifty years prior he had undergone subtotal gastroresection for peptic ulcer. Seventeen years prior to this current admission (PTA), he had an aortobifemoral bypass grafting for symptomatic peripheral artery disease, and 8 years prior he had a myocardial infarction. Three vessel coronary disease was detected and coronary-artery bypass grafting had been carried out.One year PTA, he experienced an episode of sustained ventricular tachycardia, treated with stenting of the anterior descending coronary artery, followed by an internal cardiac defibrillator (ICD) implantation. Ten months PTA, he had a massive enteric bleeding complicated by hemorrhagic shock. A colonoscopy revealed ulcerated cecal angiodysplasia that was treated with an application of metallic clips.During the following months, he was admitted several times for sideropenic anemia without evidence of acute gastrointestinal bleeding, and iron therapy was administrated. Two colonoscopies were performed but no source of active bleeding was detected.Two months PTA, he developed a low-grade fever resistent to a 2-week course of antibiotic therapy with levofloxacin.Laboratory tests showed a normocytic anemia (8.1 g/dL) with normal levels of B12 and folic acid, with low levels of sideremia (13 lg/dL), and a normal haptoglobin.An esophagogastroduodenoscopy was normal. Neoplastic markers (NSE, CA 125, CEA, were all in the normal range. Antinuclear antibody, ANCA, rheumatoid factor were negative as well as immunofixation in serum and urine.A computed tomography (CT scan) of the abdomen with contrast material confirmed ceacum angiodysplasia, but did not reveal active enteral bleeding. Transesophageal echocardiography was performed, and a vegetation on the ICD catheter was found. One blood culture was positive for Streptococcus intermedius. Treatment with amoxicillin was started, and during the hospital stay, the fever disappeared. Removal of the pacemaker was suggested, but the patient refused it. After discharge, he completed a 4-week cycle of antibiotic therapy, but after 1 week of withdrawal, fever developed again with malaise, fatigue and weight loss. He was readmitted to this hospital.On examination, the patient appeared in mild distress. He had low-grade fever (37.5°C). The Blood pressure was 100/50 mmHg, pulse rate 70 beats/min and oxygen saturation 98% while he was breathing ambient air. A grade 2/6

show abstract

Aortoenteric fistula: a diagnostic dilemma

Abstract: CT can rule in the diagnosis of AEF but cannot rule it out. CT is recommended as the first-line investigation in a stable patient with suspected AEF.

Cited by 68 publications

References 16 publications

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

Cancer-Associated Aorto-Enteric Fistula

A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease

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