Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

Abstract

BackgroundPrimary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate.Case presentationWe report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta.ConclusionsA timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.

Aortoduodenal fistula successfully treated with endovascular repair

“…Despite its rarity, accurate diagnosis is essential to initiate specific and lifesaving treatment. Our case highlights the ineffectiveness of endoscopic treatment and the importance of timely intervention using endovascular treatment for achieving hemostasis in aortoduodenal fistula 2 …”

Lumbar artery aneurysm complicated by a fistula between the aneurysm and the duodenum in a patient with Leriche syndrome: A case report

“…Traditionally, management of arterio-enteric fistula has focused on controlling hemorrhage, infection, and maintaining adequate distal perfusion [ 11 , 12 ]. The time interval between herald bleeding and massive hemorrhage ranges from hours to months [ 13 ], so immediate hemostasis is required. Endovascular repair offers a rapid control of hemorrhage in unstable patients [ 12 ]; therefore, we employed endovascular repair.…”

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

“…na fístula aortoentérica (FAE) es la comunicación espontánea entre el lumen de la aorta y una porción del tubo digestivo 1,2 . Pese a haber sido descrita por Cooper hace casi 200 años, continúa siendo difícil de diagnosticar y de tratar, con alta morbimortalidad asociada 3,4,5 .…”

“…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 .…”