Secondary aortoenteric fistulation is a well known, infrequent but serious complication after open aortoiliac reconstructive surgery. Aortoenteric ffistulaistula joyce au suny downstate grand rounds november 1, 2012. Case report successful treatment of secondary aortoenteric. Oct 31, 2015 posted in gi tagged aortoenteric, fistula, gi bleed, vascular post navigation. Aortoenteric fistulas are serious and lifethreatening complications of aortic surgery. Technical challenges include scarring from the infection and often. Secondary aortoenteric fistula after endovascular aortic. Diverse presentation of secondary aortoenteric fistulae. 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. The authors report 2 cases of primary aortoenteric fistula and discuss a number of interesting features demonstrated by them. Available in 3 configurations, and measured in both flaccid and pressurized diameter sizing safety. 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. Secondary aortoenteric fistula saf is an uncommon but very important complication of abdominal aortic reconstruction.
Successful surgical treatment of aortoenteric fistula. Similarly, in the chest, when a large thoracic aortic aneurysm compresses the esophagus. 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. Aortoenteric fistulae aef represent the most lethal subset of aortic infections. Although the ct did not show contrast in the fistula tract and bowel, the presence of gas within the aorta and the contact of a small bowel loop at adjacent location made the diagnosis highly likely. The typical presentation is a patient with gastrointestinal bleeding acute or chronic and an abdominal aortic graft, often with symptoms of infection. Particular emphasis is placed on the distinct clinicopathologic characteristics of these two types of graftenteric fistula which, if unrecognized, result in an almost invariably fatal outcome. Maefisto study highlights the characteristics of late. Early diagnosis can be achieved by computed tomography and endoscopy exploration. Aortoenteric fistula aortoenteric fistula aef is a rare, lifethreatening disease process. Aortoenteric fistula aef is an uncommon and emergency clinical condition of intraabdominal bleeding.
Oct 31, 2007 an aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding. This patient who had previous aorta repair presented with massive gastrointestinal bleed. Upper gastrointestinal bleeding is bleeding that originates proximal to the ligament of treitz. Editorial comment on aortoenteric fistula causing massive. Incidence of primary aortoenteric fistulas is estimated to be about 0. There can be significant blood loss into the intestines resulting in bloody stool and death. Pdf background aortoenteric fistula is a communication between the aorta and adjacent bowel. Look for a new 5 minute video every monday on the blog. Management of aortoenteric fistula advances in surgery. An aortoenteric fistula is a connection between the aorta and the intestines, stomach, or esophageus.
An aortoduodenal fistula is a potentially lethal complication after transperitoneal open repair of an abdominal aortic aneurysm. 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. Aortoenteric fistula allograft tissue most closely resembles the patients native tissue convenient. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of aef after open aortic repair. A 77yearold caucasian male who underwent a conventional repair of an inflammatory infrarenal aortic aneurysm, was readmitted with hematemesis only six weeks after surgery.
Aortoenteric fistula aef is an uncommon but lifethreatening condition. Four cases of aortoenteric and paraprostheticenteric fistulizations are presented. Most commonly a complication of repair of abdominal aortic aneurysms. It is rare, potentially fatal, and is difficult to diagnose and manage.
Patients presentation range from those with an occult anemia, to those with catastrophic gastrointestinal gi hemorrhage and sepsis. American university of integrative sciences school of medicine faculty advisor. The experience obtained is tabulated, and illustrative case reports are used to emphasize the diagnostic and treatment problems inherent in this group of patients. Twentyfive patients 69% had previously undergone aortic reconstruction with dacron grafts, and 11 31 % had spontaneous aortoenteric fistulas. Can form fistula anytime within life of aaa graft repair higher risk with recent graft placement. Aef is defined as an abnormal connection between the aorta or aortoiliac tree and the gastrointestinal tract. All structured data from the file and property namespaces is available under the creative commons cc0 license. Inflammatory stranding and gas between abdominal aorta and 3rd part of duodenum following aneurysm repair. Patients with an aef are commonly encountered as a medical emergency associated with acute gi bleeding.
Introduction aortoenteric stula aef is a rare and lifethreatening condition associated with diagnostic challenges. Acp michigan chapter scientific meeting 2017 medical student. Treatment of the disease is early surgical intervention. Abnormal communication between aorta and gastrointestinal tract. The prerequisite is close contact between the reconstruction and a part of the bowel, the cause being pressure and bowel erosion from an anastomotic aneurysm, the anastomotic suture line, or the graft itself. Aortoenteric fistula is a communication between the aorta and adjacent bowel. The first patient, a fiftysixyearold woman, underwent a right hemicolectomy for carcinoma in 1986 and presented three years later with massive hematemesis and hematochezia. Request pdf diagnosis and management of aortoenteric fistulas development of an aortoenteric fistula aef is a devastating and lifethreatening condition, which is as difficult to diagnose as. Aortoenteric fistula travis 1987 journal of medical. Aortoenteric fistula video journal and encyclopedia of gi. Aortoenteric fistula an overview sciencedirect topics.
The pathogenesis of aef formation after endovascular abdominal aortic repair is related to mechanical failure of the stentgraft, to. The complication often occurs months to years after aortic surgery. Aef remain rare, despite the innumerable episodes of bacteremia that people experience in their lifetime. These patients often present with a herald bleed, followed by massive gastrointestinal hemorrhage. Aortoenteric fistula definition of aortoenteric fistula. Aortoenteric fistula as a complication of open reconstruction.
Allografts offer a high resistance to infection1, 2 1. Nov 16, 2016 aortoenteric fistula left graphic shows a fistula between the transverse duodenum and aorta at the site of the graftaortic suture line. Aortoenteric ffistulaistula suny downstate medical center. At emergency laparotomy a fistulous communication was found between the fourth portion of the. Editorial comment on aortoenteric fistula causing massive bleeding. Aortoenteric fistula definition of aortoenteric fistula by. 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. Aefs are classi ed as primary or secondary depending on their etiology. An aortoenteric fistula aef is a rare but lifethreatening cause of gastrointestinal gi bleeding. Diagnosis and management of aortoenteric fistulas request pdf. During the last ten years, 14 patients with proven aortoenteric fistulas were admitted to the greenville hospital system, a community system of 1200 beds in four units serving a county of 250,000 residents. Risk factors for upper gi bleeding include medications aspirin, steroids, anticoagulation, ethanol abuse, and aortoenteric fistula after aortic graft placement. Files are available under licenses specified on their description page. Although the reported incidence of aef is low, immediate recognition and management is essential for the patients survival.
During an 11year period ending in december 1991, 36 patients with aortoenteric fistulas were assessed and treated. Secondary aortoenteric fistula after placement of aortic stent grafts has also been described. Presentations were diverse, including hematemesis, coffee. Translated from english by this website translates english to other languages using an automated tool. Aortoenteric fistula aef is a condition where there is an abnormal connection between the aorta and a loop of bowel.
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