Presentation
Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. [ncbi.nlm.nih.gov]
Intermittent gastrointestinal (GI) bleeding is the most common preceding symptom in aortoenteric fistulas, but 45% of patients with bleeding present with massive GI bleeding. 3 Thus, aortoenteric fistula should be suspected in all patients presenting [revistagastroenterologiamexico.org]
An endoluminal aortic prosthesis infection presenting as pneumoaorta and aortoduodenal fistula. [tmu.pure.elsevier.com]
Entire Body System
- Asymptomatic
At 8-month follow up, the patient was asymptomatic. [ncbi.nlm.nih.gov]
The patient had an uneventful recovery and remained asymptomatic six months later. Discussion: This is the first report of a retained guidewire causing an aortoduodenal fistula. [meeting.savs.org]
Asymptomatic Secondary Aortoduodenal Fistula Incidentally Diagnosed During a Health Check-up: A Case Report Sang Ki Park 1, In Chul Min 2, Sung Hoon Lee 1, Jae Ik Lee 1, Ji Min Kim 3, Kyong Hye Joung 3, Bon Jeong Ku 3 Departments of 1 Internal Medicine [e-agmr.org]
The patient underwent aorto-bi-femoral bypass for abdominal aortic aneurysm 2 years back [Figure 1] and was asymptomatic since then. [indjvascsurg.org]
- Surgical Procedure
Thus, it is best to consider EVAR a transitional treatment used before a definitive surgical procedure in hemodynamically unstable patients with active bleeding.12 In any event, these techniques should be accompanied by intensive antibiotic therapy for [elsevier.es]
There is limited data suggesting lower mortality in those who received additional surgical procedures with repair including debridement drainage and sac irrigation [10]. [article.sapub.org]
The recommended surgical procedure consists of closure of the duodenal fistula, aortic ligation to exclude the aneurysm, and an extraluminal bypass. [wjgnet.com]
procedures Research from SK Yazdani and coresearchers yields new findings on vascular surgery Research from TM Klem and coauthors reveals new findings on angiology Superficialization of the basilic vein technique in brachiobasilic arteriovenous fistula [books.google.es]
- Pallor
The following day, the patient’s lower extremities had increased pallor and he underwent axillofemoral and femoral-femoral bypass grafting. He went into cardiac arrest perioperatively and died. Figure 1. [acgcasereports.gi.org]
On systemic examination, the patient was found to have pallor, feeble pulse and was hemodynamically unstable with a blood pressure (BP) of 80/50, heart rate (HR) of 138 beats per minute, C reactive protein (CRP) of 96 and hemoglobin (Hb) of 6.2gm%. [tropicalgastro.com]
Case presentation We report a 65-year-old Sri Lankan man who was hospitalised with recent onset low backache and severe pallor (haemoglobin, 6 gm/dl). [casesjournal.biomedcentral.com]
- Coarctation of the Aorta
[…] polymethylmethacrylate cement fragment after kyphoplasty with insertion of inferior vena cava filter A design modification to minimize tilting of an inferior vena cava filter does not deliver a clinical benefit Open surgical repair and endovascular treatment in adult coarctation [books.google.es]
Gastrointestinal
- Hematemesis
This report describes a 73-yr-old man who developed uncontrollable hematemesis due to a primary aortoduodenal fistula in the fourth portion of the duodenum approximately 20 yr after radiotherapy and para-aortic lymph node dissection for seminoma. [ncbi.nlm.nih.gov]
After the fistula was closed, the patient repeated hematemesis and anal bleeding. She died of acute hemorrhagic shock, in spite of three operations including axillo-femoral bypass. [jstage.jst.go.jp]
She subsequently had two large volume hematemesis and several small 1-2 cups worth of hematochezia prior to arrival. She had no history of cirrhosis or NSAID use. [journals.lww.com]
- Melena
Three years after operation, melena was caused by perforation of the duodenal wall by a pseudoaneurysm at the proximal graft anastomosis. The pseudoaneurysm was treated by transluminal endovascular grafting. [ncbi.nlm.nih.gov]
Bleeding manifests as melena (81%) and, rarely, hematochezia (6%), or hematemesis (0%). [acgcasereports.gi.org]
The patient was a 44-year-old woman who repeated intermittent hematemesis and melena after hysterectomy, para-aortic lymph node dissection, and subsequent radiotherapy. Angiography revealed no bleeding point. [jstage.jst.go.jp]
Cardiovascular
- Vascular Disease
Patients with peripheral vascular disease presenting with pyomyositis may be difficult to distinguish from those with critical ischemia or synthetic graft sepsis. [ncbi.nlm.nih.gov]
Case Report A 66-year-old white man with hypertension, hyperlipidemia, COPD, lung cancer, and aortoiliac bypass graft placed 6 years prior for peripheral vascular disease, presented with 3 days of melena and syncopal events associated with bowel movements [acgcasereports.gi.org]
Other causes of a primary aortoenteric fistula stem from some type of inflammation such as syphilis, tuberculosis, mycotic infection or collagen vascular disease. [abc.go.com]
His past medical history included diabetes mellitus, chronic kidney disease, peripheral vascular disease and surgery for repair of ruptured aortic aneurysm 6 weeks ago. Systemic examination, including per rectal examination, was normal. [bjmp.org]
The results of this treatment might depend on the patient’s condition, the extent of vascular disease, and the virulence of the bacteria (8, 12, 13). [frontiersin.org]
Musculoskeletal
- Fracture
[…] acute critical limb ischemia CAPTURE 2 riskadjusted stroke outcome benchmarks for carotid artery stenting with distal embolic protection Carotid artery stenting for stenosis following cervical radiotherapy report of early failure with associated stent fracture [books.google.es]
Neurologic
- Irritability
The onset of aero digestive fistula follows the expansion of the aortic aneurysm which causes irritation and inflammation of the duodenal wall resulting in interdigestive fistulization over time [3] [4]. [scirp.org]
Because of the close approximation and fixed nature of the duodenum, the expanding nature of the AAA causes irritation and inflammation, resulting in eventual fistulization over the passage of time. [wjgnet.com]
Workup
A diagnostic workup was suggestive of a primary aortoduodenal fistula caused by erosion of an infrarenal abdominal aortic aneurysm. [ncbi.nlm.nih.gov]
As we stand now, the main diagnostic workup for suspected secondary AEF is influenced by the presence of active bleeding alongside hemodynamic instability. [ghrnet.org]
In stable patients with suspicion of an aortoduodenal fistula, workup includes gastroduodenoscopy aiming to visualize the full length of the duodenum ( Figure 5 ), CTA to assess for signs of graft infection and pseudoaneurysm formation, and sometimes [evtoday.com]
[…] vena cava for nutcracker syndrome Hybrid treatment of an ascending aortic pseudoaneurysm following multiple sternotomies Wakeup test decrease shunts insertion during carotid endarterectomy under general anesthesia Accuracy of FDGPETCT in the diagnostic workup [books.google.es]
Treatment
The patient was a 58-year-old woman given curative treatment (pancreatectomy (body and tail) + intraoperative irradiation (25 Gy)) on the basis of a diagnosis of pancreatic carcinoma. [ncbi.nlm.nih.gov]
Endovascular treatment has recently become a valid option in haemodynamically unstable patients, but a staged approach, with delayed surgical treatment, seems advisable. [academic.oup.com]
Prognosis
[…] changes Postendovascular stent Pathology Primary etiology: Abdominal aortic aneurysms, infectious aortitis, penetrating peptic ulcer, tumor invasion, radiation therapy Secondary etiology: Aortic reconstructive surgery most common Clinical Issues Very poor prognosis [sites.google.com]
CONCLUSION&58; Aorto-enteric fistulas are associated with a grave prognosis. Early diagnosis is crucial and extra vigilance should be taken in cases of inflammatory AAA. [ingentaconnect.com]
[…] retroperitoneal hematoma or hematoma within the bowel wall or lumen Secondary aortoenteric fistula increased perigraft soft tissue pseudoaneurysm formation disruption of aneurysmal wrap increased soft tissue between the graft and aneurysmal wrap Treatment and prognosis [radiopaedia.org]
Early diagnosis and treatment can improve the prognosis, but a high index of clinical suspicion is required. [elsevier.es]
Given poor prognosis family request, patient was transferred to hospice care. 3. Discussion SAEF occurs when there is an inappropriate communication between the aorta and adjacent GI tract causing massive bleeding. [article.sapub.org]
Etiology
Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. [ncbi.nlm.nih.gov]
Epidemiology
Complications of Modern Renal Revascularization 288 14 The Diagnosis and Management of Aortic Bifurcation Graft Limb Occlusions 308 15 Problems Related to ExtraAnatomic BypassIncluding Axillofemoral Femorofemoral Obturator and Thoracofemoral Bypasses 323 Epidemiology [books.google.ro]
[…] hours/days/weeks later by catastrophic hemorrhage Abdominal/back pain, palpable and pulsatile mass Intermittent rectal bleeding and recurrent anemia Low-grade fever, fatigue, weight loss, leukocytosis Demographics Age: 55 and older Gender: M:F = 4-5:1 Epidemiology [sites.google.com]
Pathophysiology
This case report covers pathophysiology, diagnostic evaluation, and management of an aortoenteric fistula. [ncbi.nlm.nih.gov]
In Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management, edn 8 (1 vol) 757–777 ( Eds Feldman M et al .) [nature.com]
In this report five cases are described in which the diagnosis was established endoscopically, and the literature regarding the pathophysiology and natural history of this entity is reviewed. [link.springer.com]
We will address the pathophysiology, diagnostic evaluation, and management of AEF. Similar articles Primary aortoenteric fistula. Cumpa EA, Stevens R, Hodgson K, Castro F. Cumpa EA, et al. South Med J. 2002 Sep;95(9):1071-3. South Med J. 2002. [pubmed.ncbi.nlm.nih.gov]
Prevention
To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. [ncbi.nlm.nih.gov]
288 14 The Diagnosis and Management of Aortic Bifurcation Graft Limb Occlusions 308 15 Problems Related to ExtraAnatomic BypassIncluding Axillofemoral Femorofemoral Obturator and Thoracofemoral Bypasses 323 Epidemiology Microbiology Pathogenesis and Prevention [books.google.ro]
After the graft was removed, we clamped the infrarenal aortic site to restore the blood flow to the kidney and prevent renal failure. [frontiersin.org]
[…] to frequent vascular surgical and aortic reconstructive procedures, and has been reported in up to 5% of cases. 3 In 1963, Humphries et al 3 reported 70 cases of aortoenteric fistula after aortic surgery, including 26 cases of their own, noting that preventive [jamanetwork.com]
Functional outcome of hypogastric revascularisation for prevention of buttock claudication in patients with peripheral artery occlusive disease Endovascular treatment of traumatic thoracic aortic injuries short and mediumterm Followup The management of [books.google.es]