Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding

Abstract

Background Aortoenteric fistula (AEF) is a rare cause of gastrointestinal bleeding and is often misdiagnosed in clinical practice. Herein, a case series of AEFs are presented and the clinical characteristics, diagnosis, and management strategies are summarized. Methods A retrospective analysis was performed on consecutive hospitalized patients with a final diagnosis of AEF at Beijing Friendship Hospital, Capital Medical University, between January 1, 2007 and March 31, 2020. The clinical data including diagnostic and management procedures as well as outcomes were collected and summarized. Results A total of nine patients were included in this study, five with primary AEF and four with secondary AEF. Eight of the patients were male, and the median age was 63 years. The fistulas were located in both the small intestine and the colon. All patients presented with gastrointestinal bleeding and pain, followed by weight loss, anorexia, and fever. A typical abdominal triad was found in only two cases. Seven patients experienced complications with preoperative abdominal infections and sepsis, and multiple organ failure occurred in four of these patients. All patients were assessed by computed tomography and five underwent abdominal and/or iliac aorta angiography. Two of these patients showed contrast agent leakage from the abdominal aorta into the intestine. Two cases were diagnosed with AEF by endoscopy before the operation. Eight patients received surgery and six patients survived. Conclusions AEF is a rare cause of gastrointestinal bleeding that is associated with high mortality. Gastrointestinal bleeding and pain are the most common presentations. Timely diagnosis and multidisciplinary management are crucial to achieve a positive outcome.

Duodenal ulcers caused by secondary aortoduodenal fistula

“…Endoscopy can help determine ADF. However, the diagnostic accuracy of ADF is 25–40% 3 . In this case, the oral side of the ulcer was between folds, possibly making it challenging to observe ADF without using an antispasmodic drug and attached hood.…”

Mycotic Aneurysm with Iliac Artery-Colonic Fistula

“…Fistulization of an iliac aneurysm into the sigmoid colon is rare and results in lower gastrointestinal hemorrhage. e clinical presentations are variable with acute or chronic, massive or slight gastrointestinal hemorrhage, such as hematochezia, hemorrhagic shock, or syncope [2]. ese patients also suffer from pain related to the location of the lesion, such as abdominal, back, or suprapubic, and prolonged fever and sepsis may present related to infection.…”

“…Concerning a vascular-colonic fistula secondary to an infected aneurysm, its unusual complication with gastrointestinal bleeding is a decisive sign of this condition. If mycotic aneurysms rupture into the bowel, patients are likely to suffer a massive hemorrhage, fulminant sepsis, or even a fatality [2]. With a leaking aneurysm, the clinical onset may be gastrointestinal hemorrhage lasting from several days to months [2].…”

“…If mycotic aneurysms rupture into the bowel, patients are likely to suffer a massive hemorrhage, fulminant sepsis, or even a fatality [2]. With a leaking aneurysm, the clinical onset may be gastrointestinal hemorrhage lasting from several days to months [2].…”

Aorto-digestive fistula: a rare cause of gastrointestinal bleeding

“…Важное преимущество перед эндоскопическими и ангиографическими методами -отсутствие риска рецидива или усугубления имеющегося кровотечения [7]. К основным признакам аорто-дигестивной фистулы по данным МСКТ относятся: газ в забрюшинном пространстве или стенке аорты (чувствительность 40 %, специфичность 100 %) [16]; сдавление и сморщивание кишечной стенки по направлению к аневризматически измененной аорте [30], исчезновение между ними жировой прослойки (чувствительность 90 %, специфичность 33 %) [15]; разрушение стенки аорты (чувствительность 89 %, специфичность 75 %), экстравазация контраста в полый орган [7]; ложная аневризма анастомоза протеза аорты рядом со стенкой полого органа со скоплением жидкости (чувствительность 90 %, специфичность 92 %), отеком и утолщением более 5 мм мягких тканей в области трансплантата [6]. Если аорто-дигестивная фистула изначально установлена по данным МСКТ, следует без диагностических и лечебных эндоскопических манипуляций направлять пациента на экстренную операцию, задержка которой может привести к летальному исходу.…”