Primary Aortoenteric Fistula after Nissen Fundoplication

Abstract

We present the rare case of a primary gastro-aortic fistula involving the native aorta and proximal stomach in a patient with a chronic gastric ulcer and prior history of Nissen fundoplication. Our case highlights the importance of keeping this rare and fatal condition as a differential diagnosis in patients with prior history of Nissen fundoplication surgery.

Primary aortogastric fistula following Nissen fundoplication: A case report

“…AGF is a very rare, often fatal condition and requires rapid recognition and treatment [ 7 ]. The diagnosis is frequently missed or made too late for surgical therapy to be effective, and mortality remains high despite intervention [ 1 , 2 , 4 , 8 ]. In many cases, the initial hemorrhage will cease spontaneously, potentially allowing sufficient time for diagnosis and surgical intervention.…”

“…In many cases, the initial hemorrhage will cease spontaneously, potentially allowing sufficient time for diagnosis and surgical intervention. This “herald bleed” has been attributed to a spasm of the intestinal musculature that closes the fistula temporarily [ 1 , 2 , 4 , 9 ]. The interval between initial hemorrhage and death from exsanguination was found to vary from several hours to 8 months [ 11 ].…”

“…Aortoenteric fistula (AEF) is an abnormal communication between the aorta and the gastrointestinal (GI) tract and may results from aortic or GI pathology [ [1] , [2] , [3] , [4] , [5] , [6] ]. It is a rare condition with an incidence of 0.04–0.07% [ 7 ].…”

“…as a complication of aortic repair (surgical or endovascular) [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. Primary AEF is much less common and refers to a communication between the native aorta and the GI tract [ 1 ]. In both primary and secondary AEF, the duodenum is the most common location, accounting for 63–81% of the cases.…”

“…We describe a case of a primary AGF that occurred 4 years after Nissen fundoplication. The purpose of this article is to raise awareness of this rare but rapidly fatal condition and the need to include it in the differential diagnosis of massive GI bleeding [ 1 , 2 , 4 , 10 ]. Treatment strategies are also postulated.…”