Primary Aorto-Duodenal Fistula with Enterococcus Foecalis Infection: A Rare But Life Threatening Etiology of Gastro-Intestinal Bleed

Abstract

Aortoduodenal fistula is a rare and serious condition. It can be primary and secondary. Clinical presentation is characterized by the classic triad of GI bleed, abdominal pain and palpable abdominal mass that occur in only 11% of cases. Accurate and rapid diagnosis should be considered since any delay has a deleterious effect on patient's life. We are reporting a case of primary aortoduodenal fistula presenting initially with acute and massive GI bleed.

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 .…”