Primary Aortoenteric Fistula to the Sigmoid Colon in Association with Intra-abdominal Abscess

Abstract

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.

Spontaneous aortoenteric fistula involving the sigmoid: A case report and review of literature

“…However, the detection rate for PEAF with gastroduodenoscopy is 25% [3] . Arteriography has a comparable low detection rate of 26%, whereas colonoscopy and ultrasound have even lower rates, respectively 10% en 0% [4] , [16] . With a detection rate of 61%, a contrast-enhanced CTa is the most reliable diagnostic tool for the evaluation of a PAEF.…”

“…With a detection rate of 61%, a contrast-enhanced CTa is the most reliable diagnostic tool for the evaluation of a PAEF. Signs that are suggestive for PAEF are the presence of contrast within the gastrointestinal tract, air within the aneurysm wall, bowel wall thickening adjacent to the aneurysm and destruction of the fat cover surrounding the aneurysm [4] , [8] , [16] . Besides to the bowel wall thickening proximately to the aneurysm, these other typical findings were not seen in our patient.…”

“…Most reports give preference to graft insertion and subsequent disconnection and closure of the fistula [2] , [3] , [6] . However, in the case of mass contamination several studies have suggested an extra-anatomical bypass [4] , [5] , [7] , [8] . Before 1991 only 32 successful operations for PEAF had been described [17] .…”

“…While secondary fistulas after aortic repair are relatively common (0.4–1.6%), PAEF is a very rare complication of abdominal aneurysms with incidences ranging from 0.04 to 0.07% [2] , [3] , [4] , [5] . While most cases of PEAF concern involvement of the third or fourth part of the duodenum, in unique cases other portions of the bowel may also be affected [4] , [6] . In this report we present an unlikely case of a primary fistula from an aortic aneurysm to the sigmoid Fig.1 .…”

Recovery aspects in a case of incomplet paraplegia with a T11 neurological level, acute postischemia due to a hemorrhageic shock through an aorto-sigmoid fistula and communicative anastomotic pseudoaneurysm – Case report

“…Aneurysms are more common in the aorta and often occur in male patients aged between 65-85, which represents 1-3% of all the causes of death in this group of age [3], [4]. The aorto-enteric fistula is a rare cause of massive gastrointestinal bleeding, which could have catastrophic consequences through the hemorrhagic shock caused, many such fistulae leading to the death of the patient [5], [6]. There may be medullary ischemia due to the massive loss of blood, which may be presented through a wide range of clinical manifestations: pain, motor deficit, sometimes the impairment of the sphincter control.…”