Primary Aortoduodenal Fistula in Patients with Rheumatoid Arthritis

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

“…We report a case of primary aorto duodenal fistula presenting with lower GI bleed, secondary to infected aneurysm with Enterococcus foecalis treated surgically and medically with good final outcome. Till date less than 300 cases of PADF have been reported in the literature [4]. The incidence of PADF is 0.04-0.07 % [5].…”

“…Aneurysm constitutes 70% of cases, but aortitis (infectious or inflammatory) can be a cause [6,7]. Other possible factors are tumors, foreign body, radiotherapy, diverticulitis, appendicitis, gallstones, ulcers and infection mainly salmonella and klebsiella but sometimes tuberculosis, syphilis, mycosis, streptococcus and staphylococcus [2,4,6,7]. In addition, case reported by Dilek et al showed PADF in patient with rheumatoid arthritis on steroid therapy which can be the risk factor of connective tissue fragility and fistula formation [4].…”

“…Even with surgical treatment, the mortality is 18 to 93% [4]. PADF associated with infected aneurysm has a worse prognosis than ADF associated with aneurysm alone with postoperative mortality more than 50% [2].…”