The clinical presentation can be confusing, leading to a delay in diagnosis. The pathogenesis of aef formation after endovascular abdominal aortic repair is related to mechanical failure of the stentgraft, to. Prompt diagnosis of aortoenteric fistulas is imperative for patient survival. Nov 09, 2018 a patient with an anal fistula may complain of recurrent malodorous perianal drainage, pruritus, recurrent abscesses, fever, or perianal pain due to an occluded tract. An unusual case of a primary aortoenteric fistula with an atypical presentation is described.
Jun 12, 2010 care of av fistula keep the fistula arm raised on a pillow to reduce swelling. Any patient presenting with gastrointestinal hemorrhage and a history of aortic reconstruction should be considered to have an aortoenteric fistula until proven otherwise. Diverse presentation of secondary aortoenteric fistulae. Aortoenteric fistula definition of aortoenteric fistula. A primary aortoenteric fistula forms when a large abdominal aortic aneurysm closely abuts bowel loops, usually the 3 rd or 4 th parts of the duodenum. Introduction aortoenteric stula aef is a rare and lifethreatening condition associated with diagnostic challenges.
It rises from the hearts left ventricle the major chamber that pumps blood out of the heart and is filled with oxygenrich blood that travels throughout the body. Introduction aortic graft infection with secondary aortoenteric fistula is a rare complication to aortic surgery, associated with increased morbidity and mortality 1, 2. Abnormal communication between aorta and gastrointestinal tract. It is rare, potentially fatal, and is difficult to diagnose and manage. Diagnosis and management of aortoenteric fistulas request pdf. Aortoenteric fistula aortoenteric fistula aef is a rare, lifethreatening disease process. Computed tomography ct can greatly assist in establishing the diagnosis. Oct 31, 2007 an aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding.
The abdomen was entered and loa until the area of the proximal anastomosis. Successful surgical treatment of aortoenteric fistula. The diagnosis of aortoenteric fistula can be as challenging as diagnosing an early graft infection. Enter your email address to follow this blog and receive notifications of new posts by email.
An aortoenteric fistula is a connection between the aorta and the intestines, stomach, or esophageus. Aortoenteric fistula after endovascular stent grafting for. Aortoenteric fistula is a communication between the aorta and adjacent bowel. B with the first presentation, the patient underwent axillobifemoral bypass, with ligation of the aortic graft. The presentation of an aortoenteric fistula can be seen months to years following the original operation, and clinical suspicion remains the cornerstone for diagnosis. The patient originally underwent aortobifemoral bypass with a side branch to the left renal artery yellow arrow. Aortoenteric fistura in a special case of rupture of the abdominal aortic aneurysm. Aortoenteric fistula an overview sciencedirect topics. A 69yearold male patient with a history of panperitonitis caused by rectal perforation underwent evsg for an aaa. As soon as post operative pain has subsided, start arm exercises do not allow blood pressure, blood taking or intravenous administration on the fistula arm. Aortoenteric fistula travis 1987 journal of medical. The disease is divided into two typesprimary and secondary aef. Aortoenteric fistula aef is a rare clinical entity that was first described in 1818 by sir ashley cooper. Computed tomography with contrast medium is often the preferred test in emergent cases, with sensitivity and specificity up to 94% and 85%, respectively.
Aef remain rare, despite the innumerable episodes of bacteremia that people experience in their lifetime. Twentytwo patients developed one or more aortoenteric fistulae following aortic reconstruction with a dacron graft. The complication often occurs months to years after aortic surgery. Aef is defined as an abnormal connection between the aorta or aortoiliac tree and the gastrointestinal tract.
Nov 16, 2016 aortoenteric fistula left graphic shows a fistula between the transverse duodenum and aorta at the site of the graftaortic suture line. During the same period, 32 patients presented with an aef during evar followup, 21 with original evar performed for atherosclerotic aneurysmal disease ats group and 11 with the original evar performed for a postsurgical pseudoaneurysm psa group. Pain occurs with sitting, moving, defecating, and even coughing. Look for a new 5 minute video every monday on the blog. A fistula is an abnormal, tubelike connection between two. Aortoenteric fistula aef is a condition where there is an abnormal connection between the aorta and a loop of bowel. Aortoenteric fistula aef aortoenteric fistula aef share. While the classic clinical presentation of patients with an aortoenteric fistula has been described with the triad of abdominal pain, massive gastrointestinal hemorrhage, and a pulsatile abdominal mass, many patients demonstrate only vague abdominal pain on initial presentation. How to get rid of muscle knots in your neck, traps, shoulders, and back duration. Technical challenges include scarring from the infection and often. Secondary aortoenteric fistula, due to mechanical erosion or infection of a prosthetic graft, is a very rare cause of gastrointestinal bleeding and an uncommon complication of abdominal aortic aneurysm repair. The patient presented with symptoms indicating an exacerbation of recurrent nephrolithiasis.
Results from the multicenter study on aortoenteric. However, evidence regarding aortoenteric fistula is scant in the existing literature, largely based on singlecentre case reportsto date 53 aortoenteric fistula patients have been documented in 20 case reports and seven small series. Noncurative surgery for aortoenteric fistula journal of. Incidence, presentation recognition, and management. Both mri and ct can fail to diagnose graft enteric fistulas. While secondary aortoenteric fistulas saefs are more common and arise after aortic reconstruction, primary aortoenteric fistulas paefs are generally caused by abdominal aortic aneurysms aaas. The typical presentation is a patient with gastrointestinal bleeding acute or chronic and an abdominal aortic graft, often with symptoms of infection. Incidence of primary aortoenteric fistulas is estimated to be about 0. The clinical signs of aortoenteric fistula include hematemesis, melena, sepsis, and abdominal pain, but the condition also may be clinically occult. Rupture of the abdominal aortic aneurysm occurs at the third portion of the duodenum in most cases. The patients often present with a herald bleed, followed by massive gastrointestinal gi hemorrhage. There can be significant blood loss into the intestines resulting in bloody stool and death. Endoscopy was performed on 11 of these patients on 17 occasions and a preoperative. Takedown aortoenteric fistula medical billing and coding.
J t lee, r m saroyan, g belzberg, n a pianim, f s bongard annals of vascular surgery 2001, 15 2. Primary aortoesophageal fistula in a 61yearold man with a 3week history of intermittent vomiting. The patient was a 70yearold man who complained of hematemesis and melena. Aortoenteric fistulas aefs are deadly, abnormal connections between the aorta and gastrointestinal gi tract. Elected to takedown of the enteric side of the fistula with interposition omental patch to attempt to prevent infection of the aortic graft. The objective of presenting this case report is to discuss the radiological findings of primary aortoenteric fistula in a patient presenting with acute. We describe a case report of a 46 year old woman presenting to the emergency with shock and a history of melena and was subsequently accurately diagnosed to have an aortoenteric fistula. Aortoenteric fistula after endovascular stent grafting for an. Although preoperative diagnostics showed no definitive signs of endograft infection, eventual surgical exposure of the endograft revealed signs of advanced inflammation, including the unexpected finding of an aortoduodenal fistula. A this patient suffered a recurrent aortoenteric fistula after attempted aortic stump ligation. Computed tomographic angiography cta can be used to detect primary adf.
An aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding. Aef as a fatal complication of overlap esophagojejunostomy after esophagogastrectomy has not been reported previously. Aortoenteric fistula definition of aortoenteric fistula by. Similarly, in the chest, when a large thoracic aortic aneurysm compresses the esophagus. Aortoenteric fistula as a rare manifestation of rupture of an abdominal aortic aneurysm. It usually is throbbing in quality and is constant. Patients presentation range from those with an occult anemia, to those with catastrophic gastrointestinal gi hemorrhage and sepsis. Management of aortoenteric fistula advances in surgery. Can form fistula anytime within life of aaa graft repair higher risk with recent graft placement. These fistulas can be divided into primary and secondary forms, depending on the presence or absence of. Aortoenteric fistula aef, occasionally reported as a fatal complication after aortic or other vascular procedures, is a communication between the aorta and the digestive tract. While endograft repair can be effective at mitigating the immediate lifethreatening bleed, the temptation to consider endograft repair as definitive treatment should be resisted.
Jan 09, 2017 carotid cavernous fistula slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. M c champion, s n sullivan, j c coles, m goldbach, and w c watson. Most commonly a complication of repair of abdominal aortic aneurysms. Aortoenteric fistula as a complication of open reconstruction. Outcomes depend on the promptness of the diagnosis and time until surgery. Aortoenteric fistula is a rare, lifethreatening disease process most commonly a complication of repair of abdominal aortic aneurysms aaa. Paefs may present with selflimited gi bleeds called herald bleeds, and the. Operative management is the only solution for correction of aortoenteric. Although the reported incidence of aef is low, immediate recognition and management is essential for the patients survival. Aortoenteric fistula gastrointestinal bleeding perigraft infection open surgical repair endovascular repair complications aortoenteric fistula aef is a rare clinical entity that was first described in 1818 by sir ashley cooper. It is usually secondary to an abdominal aortic aneurysm repair. Incidence, presentation recognition, and management article pdf available in annals of surgery 1953. Herein, we report a case of aef after laparoscopic proximal gastrectomy and transhiatal. Endograft infection due to secondary aortoenteric fistula.
Right axial cect in a 70yearold man presenting with fever and hematemesis months after abdominal aortic aneurysm aaa repair shows the native, calcified aortic wall wrapped around a synthetic graft. Secondary aortoenteric fistula possibly associated with. Please visit the project page for details or ask questions at wikipedia talk. Primary aortoduodenal fistula associated with abdominal. Aortoenteric fistula as a rare manifestation of rupture of. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources.
The aortic bulge sign has been retrospectively identified as a promising computed tomography finding of eventual aortoenteric fistula prior to acute presentation. Note highdensity material in distal small bowel and patent axillofemoral bypass graft in soft tissues of right anterior abdomen. A ct shows a small focus of air arrow adjacent to aortic graft. These fistulas can be divided into primary and secondary forms, depending on the.
Dec 29, 2011 secondary aortoenteric fistula, due to mechanical erosion or infection of a prosthetic graft, is a very rare cause of gastrointestinal bleeding and an uncommon complication of abdominal aortic aneurysm repair. A gas collection is noted between the graft and aortic wall, indicating infection or fistula. Translated from english by this website translates english to other languages using an automated tool. The patient could not have the entire graft removed at the time. Further study is required to determine the diagnostic value of this sign. Aortoenteric fistula following overlap esophagojejunal. Of these complications, an aortoenteric fistula is considered a dramatic and lethal problem. The aortoenteric fistula recurred twice, but the patient has survived more than 12 years following noncurative surgery with good quality of life.
Oct 31, 2015 enter your email address to follow this blog and receive notifications of new posts by email. It is most often the result of primary compression of the aorta eg, abdominal aortic aneurysm against, or erosion of an aortic prosthetic graft into, the. Therefore, the role of the radiologist is critical in the management of paef. Clinical presentation may vary from a herald bleed to a lifethreatening deadly bleeding if left untreated. Aortoenteric fistula aef is an uncommon but lifethreatening condition. A total of 3932 patients underwent evar between 1997 and 20 at the participating centers. Patients with a secondary aortoenteric fistula usually present with one or more of the followfigure 3. The prognosis of the aortoenteric fistula in poor because io causes hematemesis, melana and sepsis. Patients with an aef are commonly encountered as a medical emergency associated with acute gi bleeding. Aortoenteric fistula, a rare but potentially fatal entity, presents a significant challenge to radiologists in diagnosis, largely because of its subtle and nonspecific imaging findings. Aortoenteric fistula is a devastating complication of aortic aneurysm repair.
Secondary aortoenteric fistula saf is an uncommon but very important complication of abdominal aortic reconstruction. We report a case of an aortoenteric fistula aef developing after endovascular stent grafting evsg for an abdominal aortic aneurysm aaa. Presentation is acute or chronic, and ct scanning and endoscopy are the primary modalities to confirm aortoenteric fistula. A 75yearold male patient was admitted with suspected endograft infection 4 years after endovascular aortic aneurysm repair evar. Traditional repair carries a high risk of mortality and significant morbidity. Patients may report a recent perianal or buttock abscess. Inflammatory stranding and gas between abdominal aorta and 3rd part of duodenum following aneurysm repair. Secondary aortoenteric fistula is a rare but fatal complication after. Clinicians should keep a high level of suspicion for an unknown etiology of gi bleeding, especially in older patients with or without abdominal aortic aneurysm aaa. Takedown aortoenteric fistula indication for surgery. Presentations were diverse, including hematemesis, coffee.
If you continue browsing the site, you agree to the use of cookies on this website. Aortoiliac occlusive disease leriche syndrome background research. Aortoenteric fistulae aef represent the most lethal subset of aortic infections. Primary aortoenteric fistula is usually caused by an untreated abdominal aortic aneurysm, whereas secondary aortoenteric fistula occurs as a complication of an abdominal aortic aneurysm repair. A primary aortoenteric fistula is a potentially devastating complication of untreated aortic aneurysmal disease.
219 1216 1452 1043 582 110 147 1100 13 1239 134 1422 230 1191 600 1359 612 199 712 686 8 1525 1257 543 50 938 1355 914 1163 1455 196 59 881 701 1153 1394 639 693 1045 1252 821 1396 467 328 504 777 218 1220 760