Primary aortoduodenal fistula: a rare entity with lethal effects

Abstract

Primary aortoduodenal fistula (ADF) is a rare but morbid diagnosis. Here, we present the case of a patient with a primary ADF that resulted in mortality. Despite multiple attempts at radiographic and endoscopic diagnosis, the fistula did not declare itself until the patient exsanguinated. Given the morbidity associated with ADF and the imperfection of associated diagnostic studies, a high index of suspicion is required to make a timely diagnosis.

Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

“…Less than 5% will present with haemorrhagic shock without previous episodes of minor bleeds [ 10 ]. The term 'herald bleed' is a sign where the patient complains of intermittent haematemesis or haematochezia up to 3 weeks prior to the massive haemorrhagic episode [ 11 ]. This sinister sign should raise suspicion of AEF even in the absence of positive endoscopic findings as it can be the only opportunity for early therapeutic attempts [ 12 ].…”

“…Richards et al, mention the benefit of permissive hypotension during the resuscitation of patients with bleeding aorto-duodenal fistula [ 11 ]. Surgical approaches changed over the years.…”

“…If primary repair of the small bowel is not possible, then resection and anastomosis is recommended. Primary suturing of small defects is appropriate, but omental flap interposition or duodenal switch are recommended for larger defects as there is a high risk of recurrence with suturing alone [ 11 , 14 ].…”

“…A high index of suspicion is required to diagnose PADF as this may be missed with endoscopy alone. CT with IV contrast is considered the most effective method to diagnose PADF provided the patient is relatively haemodynamically stable [ 5 , 11 ]. Although surgery is the definitive treatment of PADF, in the immediate setting it can also be treated using a covered stent-graft.…”

Aneurisma de aorta abdominal roto al duodeno: causa infrecuente de hemorragia digestiva masiva

“…Su frecuencia es extremadamente baja, siendo 0,04-0,07% de las autopsias 1,4,6 . Se han reportado menos de 400 casos, siendo la mayoría reportes de casos únicos 1,3,4,[6][7][8] y escasas revisiones de casos acumulados 2,5,9 . Las FAE se clasifican en primaria, cuando existe una comunicación espontánea entre la aorta nativa, generalmente un aneurisma aórtico abdominal (AAA) y un segmento del tubo digestivo, y FAE secundaria, cuando existe cirugía aórtica previa, siendo 10 veces más frecuente que la FAE primaria 4,6 .…”