Primary aortoenteric fistula in the Emergency Department

Mirarchi, Ferdinando L.; Scheatzle, Mark D.; Mitre, Ricardo

doi:10.1016/s0736-4679(00)00288-2

Cited by 17 publications

(10 citation statements)

References 8 publications

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“…Radiation, metastases, pancreatic carcinoma, duodenal ulcers, gallstones, diverticulitis, appendicitis, and cystic medial necrosis are rare causes of a primary AEF (6). Although the most common infectious causes are Salmonella and Klebsiella, other less common agents such as tuberculosis, syphilis, fungi, Staphylococcus, and Streptococcus also have been reported (7). The distal duodenum is anterior to the aorta and fixed, making this the most common location for an AEF to occur.…”

Section: Discussionmentioning

confidence: 99%

Aortoenteric Fistula

Ozcakir

Sherman

Kern

2011

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Aortoenteric Fistula

Ozcakir

Sherman

Kern

2011

The Journal of Emergency Medicine

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“…Other reasons except atherosclerosis leading to enteric communication are infection, radiation therapy, peptic ulcer, gallstones, pancreatitis, diverticular diseases, foreign bodies, metastatic cancer, pseudoaneurysm associated with cystic medial necrosis, and post‐traumatic pseudoaneurysms 1‐7 . Because of close contact with the abdominal aorta, third portion of the duodenum is the most common site of the AEF followed by jejenum, ileum, colon, esophagus, and stomach 8,9 …”

Section: Discussionmentioning

confidence: 99%

Primary Aortoenteric Fistula Associated With Giant Aortic Pseudoaneurysm

Kalko¹,

Murat²,

Ünal³

et al. 2007

J Cardiac Surgery

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“…A literature search of the CINHAL, Embase and MEDLINE databases using the search terms ‘arteriosclerosis’, ‘fistula’, ‘aortic diseases’, ‘aortic aneurysm’, ‘esophageal fistula’, ‘aorta aneurysm’ and ‘aortointestinal fistula’ returned four key references 1–4…”

mentioning

confidence: 99%

Mind the fistula

Burns

Vijayasankar

2011

Frontline Gastroenterol

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Thoracic aortic dissection (TAD) with aortooesophageal fi stula formation is an uncommon but fatal cause of haematemesis. A case is presented of a previously healthy 63-yearold man who presented to the emergency department with syncope and haematemesis. He had no history of heavy alcohol intake and was previously well. Bedside portable chest x ray revealed a widened mediastinum and, while awaiting a CT angiogram, he had a further large haematemesis which led to him undergoing resuscitation and rapid sequence intubation. CT angiography of his thoracic aorta revealed a large thoracic aortic aneurysm with dissection from the arch of the aorta down to the left iliac artery. The dissection had formed an aorto-oesophageal fi stula in the proximal oesophagus. He was transferred to a tertiary referral centre for repair of the dissection and aorto-oesophageal fi stula.A 63-year-old man presented to the emergency department complaining of a sudden onset of feeling unwell, followed by a syncopal episode while seated and an episode of vomiting bright red blood. In addition, he complained of a 15 week history of interscapular back pain which was being managed in the community with Co-codamol 30/500. Despite this, the pain had persisted. He gave no history of alcohol abuse or upper gastrointestinal symptoms. He denied any abdominal pain or any history of melaena. Review of his systems revealed only that he had experienced a recent history of dysphagia to solids. His past medical history was significant for hypertension and hypercholesterolaemia and he was a smoker of one or two cigarettes per day and denied any illicit drug use.On physical examination, the patient was pale, diaphoretic and clinically shocked. Despite this, his vital signs remained within normal limits. He received 500 ml of 0.9% saline by the ambulance crew as his initial blood pressure on scene was noted to be 96/54 mm Hg. Subsequent blood pressure checks in his left and right arms revealed a blood pressure of 127/87 and 115/74 mm Hg, respectively. The cardiovascular examination revealed no murmurs, rubs or gallops and his lung sounds were clear to auscultation. His abdominal examination revealed a soft, non-tender abdomen. His neurological examination was grossly intact.A venous blood gas, obtained while the patient was breathing room air, revealed a pH of 7.13, pCO 2 8.23 kPa, pO 2 4.37 kPa, HCO 3 20.1 mmol/l, BE −9.0 mmol/l, haemoglobin 9.4 g/dl and haematocrit 31.7%. An ECG revealed normal sinus rhythm only. His portable chest x ray revealed a widened mediastinum. While awaiting CT aortogram, the patient had a large haematemesis, 800 ml of fresh blood, and became increasingly pale, diaphoretic and agitated. He was resuscitated and underwent rapid sequence intubation with etomidate and suxamethonium and was given type O negative blood and intravenous omeprazole. He was transferred for CT aortic angiography which revealed a large thoracic aortic aneurysm measuring approximately 8 cm in AP diameter. There was a prominent Stanford type B dissection within it...

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Primary aortoenteric fistula in the Emergency Department

Cited by 17 publications

References 8 publications

Aortoenteric Fistula

Aortoenteric Fistula

Primary Aortoenteric Fistula Associated With Giant Aortic Pseudoaneurysm

Mind the fistula

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