Secondary Aortoduodenal Fistula Presenting as Gastrointestinal Bleeding and Fungemia

Abstract

A 55‐year‐old African American man with a history of abdominal aortic pseudoaneurysm repair presented to the ED with complaints of black-colored stools mixed with fresh blood and fever for three days duration. The exam was unremarkable except for abdominal bruits and pallor. CT angiogram showed perigraft fluid collection, bowel wall thickening, and loss of normal fat planes between the aorta and adjacent bowel at the level of the third portion of the duodenum. Polymicrobial infection was noted in the aortic graft and blood cultures grew Candida. The patient underwent urgent removal of the infected graft, duodenal repair along with appropriate antimicrobial therapy. He did well postoperatively and was discharged in a stable condition. Our case highlights the importance of maintaining a high index of suspicion of aortoenteric fistula (AEF) when a patient with a prior abdominal aortic graft develops gastrointestinal (GI) bleeding as this condition is universally fatal if unrecognized.

A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia

“…Candida fungemia is rare presentation of aortoenteric erosion. Vegunta et al reported a case of aortoiliac graft erosion in the duodenum presenting as Candida albicans fungemia and bloody bowel movements [12]. The presentation in our case was unique because the patient presented with signs of sepsis from Candida fungemia without any evidence of gastrointestinal bleeding.…”

First case report of gastric outlet obstruction due to aortofemoral bypass Dacron graft erosion of the duodenum treated with neo aortoiliac system procedure

“…During our search, we did not find any case report of secondary AEF presenting with gastric outlet obstruction and treated with a NAIS procedure and this makes this case unique. The presence of gastric outlet obstruction syndrome and previous aortic synthetic graft must obligate the vascular surgeon in charge to rule out aortoduodenal fistula and help in the early diagnosis of this life-threatening condition [1] , [18] , [19] . Finally, the patient understood his condition and was satisfied with the approach taken and effort made by the medical team.…”

“…AEFs are uncommon but life-threatening conditions. Prosthetic aortic grafts can develop AEF due to mechanical erosion and infection of the surrounding gastrointestinal structures [1] , [2] . AEF is an abnormal communication between the aorta/aortic graft and an adjacent loop of the bowel.…”

“…Primary AEFs occur when a previously untreated aneurysm erodes the adjacent bowel. Secondary AEF can occur due to open aortic synthetic graft or endovascular aneurysm stent-graft [1] , [2] , [3] .…”

Bilayer charge asymmetry and oil residues destabilize membranes upon poration

“…The assay requires precaution, since sodium dithionite is a strong reducing agent and unstable in aqueous solutions [60]. Depending on concentration, pH and oxygen access, dithionite shows different reactions [61]. Consequently, the optimization of substance handling and reaction conditions are crucial.…”