Presentation
Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. [ncbi.nlm.nih.gov]
Entire Body System
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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]
Gastrointestinal
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Hematemesis
Symptoms of ADF consist of flank or abdominal pain, hematemesis, melena, and an abdominal mass. [ncbi.nlm.nih.gov]
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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]
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]
Symptoms of ADF consist of flank pain or abdominal pain, hematemesis, melena, and an abdominal mass. ADF is curable, if diagnosed and treated with surgical intervention before the onset of lethal massive hemorrhage. [e-ce.org]
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Loss of Appetite
She was later discharged again on conservative treatment, and followed up at the outpatient clinic, but nine months postoperatively, was readmitted complaining of loss of appetite and abdominal pain. [ncbi.nlm.nih.gov]
Furthermore, 30- day postoperatively, the patient complained of loss of appetite and abdominal distension due to ascites ( Figures 2A and 2B ). [omicsonline.org]
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Abdominal Bruit
An aortocaval fistula can be discovered when a patient presents with an abdominal bruit or cardiomegaly with or without heart failure. The diagnosis of an aortoenteric fistula is difficult because of the subtleties in manifestation. [ncbi.nlm.nih.gov]
CASE PRESENTATION A 77-year-old Caucasian man consulted his general practitioner concerning a two-week history of worsening weakness and was referred to our emergency department upon detection of an abdominal bruit. [academic.oup.com]
Cardiovascular
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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]
Cardiovascular and vascular disease of the aorta. Philadelphia: WB Saunders; 1997:126-52. [ Links ] 23. Walker WE, Cooley DA, Duncan JM, Hallman GL, Ott DA, Reul GJ. [scielo.br]
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]
[…] 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]
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]
Microbiology
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Coxiella Burnetii
We describe the clinical symptoms, diagnostic tools for detection of Coxiella burnetii infection and treatment. KEYWORDS: aorta abdominal aneurysm; chronic Q-fever; primary aortoduodenal fistula [ncbi.nlm.nih.gov]
We report a rare case of primary aortoduodenal fistula (ADF) secondary to a Coxiella burnetii (Q fever) infection in a patient with an abdominal aortic aneurysm. [uthscsa.influuent.utsystem.edu]
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]
Prognosis
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]
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]
[…] 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]
[…] 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]
Despite the advancements in treatment of aortoduodenal fistulas and state-of-the-art intensive care, the prognosis remains poor, with an overall 30-days survival of 30–44% [4] [5]. [ijcasereportsandimages.com]
Etiology
Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. [ncbi.nlm.nih.gov]
Physician should consider the diagnosis of aortoduodenal fistula in patients with even mild upper gastrointestinal bleeding of uncertain etiology and abdominal pulsatile mass. [jstage.jst.go.jp]
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
We will address the pathophysiology, diagnostic evaluation, and management of AEF. [ncbi.nlm.nih.gov]
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]
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]
Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 1996;76:1009–1018. 11. Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery 1984;96:492–497. 12. [synapse.koreamed.org]
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]
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]
In most cases, a prosthetic graft replacement not only prevents rupture, but also regresses the inflammatory process. [omicsonline.org]