Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula

Sevilla, Elena Fernández de; Echeverri, Juan; Boqué, M.; Valverde, Silvia; Ortega, Nuria; Gené, Anna; Rodríguez, Nivardo; Armengol, Manel

doi:10.1016/j.ijscr.2015.01.010

Cited by 9 publications

(10 citation statements)

References 15 publications

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“… 4 The most important prognostic factor is by far PAEF’s early diagnosis. 6 PAEFs are clinically revealed by GI bleeding in approximately 80% of the cases but the classic triad of GI bleeding, pulsating abdominal mass and abdominal pain occurs only in 25% of PAEF cases. 4 …”

Section: Discussionmentioning

confidence: 99%

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A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it

et al. 2022

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Although gastrointestinal hemorrhage from aorto-enteric fistulae (AEF) secondary to previous aortic grafts are well known, a primary aorto-enteric fistula (PAEF) without aortic aneurysm is an extremely rare event resulting in poor prognosis and outcome. PAEF is a rare cause of gastro-intestinal (GI) bleeding that radiologists should consider because often its presence is not easily guessed by clinical features. It is difficult to detect at Computed Tomography (CT) examination therefore PAEF might be not diagnosed until a laparotomy. We report a case of a 74-year-old Italian male who presented to our Emergency Department (ED) with brightly red rectal bleeding that occurred from some hours and a pre-syncopal episode. There was no history of analgesic abuse, peptic ulceration, alcohol excess, weight loss. Standard resuscitation was commenced with the hope that common sources of bleeding such as peptic ulcers or varices would eventually be discovered by endoscopy and treated definitely. An upper GI endoscopy showed brightly red blood in the stomach and in the first portions of duodenum, but no source of active bleeding was found. Diagnosis of PAEF was made by Computed tomography (CT) and after confirmed during surgical intervention. Both the duodenum and the aorta were successfully repaired by direct suture and synthetic graft replacement respectively. Diagnosis of primary aortic duodenal fistula (ADF) has been very difficult in this case especially because our patient didn’t have abdominal aortic aneurism (AAA) history confirmed by CT examination. Radiologist should remember that upper GI bleeding could however be determined by primary ADF also if atherosclerotic damage is severe as in this case. A technically good and complete exam is mandatory to achieve this rare and complex diagnosis. Particularly, an ultra-tardive acquisition phase (5 min after contrast administration) could be helpful to suspect the presence of PADF: the appearance of contrast into the duodenal lumen is an evocative sign useful to increase clinical and radiological suspicious of ADF. Gl bleeding should be assumed to be caused from a PAEF unless another source can be identified without delay. A timely and accurate diagnosis of primary AEF may be challenging due to insidious episodes of GI bleeding, which are frequently under diagnosed until the occurrence of massive hemorrhage.

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Section: Discussionmentioning

confidence: 99%

“…However, lesions without active bleeding founded through endoscopy do not rule out an ADF 9,10 ; moreover, as in our patient, the length of the endoscope does not permit the visualization of the distal duodenum where ADF often occurs. 6 …”

Section: Discussionmentioning

confidence: 99%

A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it

et al. 2022

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“…Emergent surgical treatment is the best chance of survival of these patients. Endovascular approach in selected cases may ameliorate complications associated with surgery [24].…”

Section: Discussionmentioning

confidence: 99%

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

Abboud¹

2019

GMR

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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.

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“…A possible mechanism by which fistulization occurs is the constant pressure and pulsation exerted externally by the aneurysm on the bowel wall, leading to ischemia and ulceration into the lumen. 7 Similar to cases of aortoenteric fistula, patients may present with a herald bleed, which is a smaller bleed that precedes a catastrophic bleed. The typical interval between the herald bleed and subsequent catastrophic hemorrhage is unknown, but a lag time of 6 days has been reported for aortoenteric fistulas.…”

Section: Discussionmentioning

confidence: 99%

Massive Gastrointestinal Hemorrhage Due to an Arterioenteric Fistula From a Hepatic Artery Pseudoaneurysm

Takatori

Patel

2018

ACG Case Reports Journal

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Hepatic artery pseudoaneurysms are a rare cause of upper gastrointestinal bleeding with a high mortality rate. We report a case of a 37-year-old woman who presented with massive gastrointestinal hemorrhage and was found to have an arterioenteric fistula from a hepatic artery pseudoaneurysm. Esophagogastroduodenoscopy revealed a 1.5-cm ulcer overlying a large mucosal bulge that compressed the lumen of the duodenal bulb. A vascular stent graft was placed successfully over the pseudoaneurysm neck. We report the first case of the unique intraluminal appearance of an enteric fistula related to a hepatic artery pseudoaneurysm.

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Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula

Cited by 9 publications

References 15 publications

A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it

A singular case of primary aorto-duodenal fistula without pre-existing abdominal aortic aneurism: why and when you should suspect it

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

Massive Gastrointestinal Hemorrhage Due to an Arterioenteric Fistula From a Hepatic Artery Pseudoaneurysm

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