Aortoenteric Fistula
Case description
Patient and methods
A 67 year old man presented with right upper quadrant pain, hematochezia and hypotension. Two months ago, the patient underwent elective open repair of an abdominal aortic aneurysm. On upper endoscopy, fresh blood and adherent clots were seen in the third/fourth portion of the duodenum. After some of the clots were gently washed off with water flushing, a fistula opening was seen on posterior superior wall of the duodenum. The fistula opening was surrounded by edematous duodenal mucosal. An aortoenteric fistula was highly suspected and the patient went to emergent laparotomy.
Results
During surgery, significant inflammation was noted surrounding the aorta with friable tissues of the aorta itself. A definite aortoenteric fistula was seen arising in the native aorta. Unfortunately, the patient expired due to cardiac vascular collapse.
Conclusions
Diagnosis of aortoenteric fistula requires a high index of suspicion and careful history-taking. Endoscopic findings include adherent clots or bleeding at the fistula opening and/or eroded vascular graft or stent into the bowel.
Authors
Shou-Jiang Tanga, Srikrishna Patnanaa, Ruonan Wub, Andrew Rivardb,
READ THE FULL ARTICLE ON OUR OPEN ACCESS VIDEO JOURNAL & ENCYCLOPEDIA HERE:
http://www.sciencedirect.com/science/article/pii/S2212097114000314
Keywords
Endoscopy; Duodenum; Gastrointestinal bleeding; Aortoenteric fistula; Computed tomography; Abdominal aortic aneurysm; Video
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