Aortoenteric Fistula-An Uncommon Cause of Gastrointestinal Bleeding. A Review of the Literature

Abstract

Aortoenteric fistula is a pathological communication between the aorta and any portion of the gastrointestinal tract. It is a rare cause of upper or lower gastrointestinal bleeding. Clinical presentation may vary from a "herald" bleed to a life-threatening deadly bleeding if left untreated. Primary aortoenteric fistula is usually caused by an untreated abdominal aortic aneurysm, whereas secondary aortoenteric fistula occurs as a complication of an abdominal aortic aneurysm repair. Diagnosis is often difficult and delayed. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Urgent surgery is still the recommended treatment. In this article, we aim to provide a comprehensive update on the type, diagnosis, management, and prognosis of aortoenteric fistulas.

The Challenges of diagnosing and managing a ruptured abdominal aortic aneurysm with primary aortoduodenal fistula.

“…It is often used first line if the patient presents with upper GI bleeding 14 as it is useful in ruling out other causes of upper GI bleeding. It may reveal associated pathology 17 or even highly suggestive findings such as a pulsatile mass in the duodenum18 but while there are many reports in the literature of EGD being diagnostic for secondary aortoenteric fistulas, diagnosis of a primary fistula usually requires confirmation from a second imaging modality if EGD is the initial approach 19,20 . A negative EGD is certainly not sufficient to rule out an aortoenteric fistula 5,6 .…”