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      Diverse Presentation of Secondary Aortoenteric Fistulae

      case-report
      Author(s): * ,
      Publication date (Electronic):
      Journal: Case Reports in Medicine
      Publisher: Hindawi Publishing Corporation

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          Abstract

          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 retrospective chart review conducted at our institution revealed 5 cases of secondary AEF occurring between 2006 and 2010. Presentations were diverse, including hematemesis, coffee-ground emesis, and unexplained sepsis. Delay in diagnosis was common. In reporting these cases, we seek to highlight the diverse clinical spectrum and potentially misleading features of this condition. Clinicians must retain a high index of suspicion to avoid potentially catastrophic outcomes.

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          Diagnosis and management of aortoenteric fistulas.

          J Goldstone, S Busuttil (2001)
          Development of an aortoenteric fistula (AEF) is a devastating and life-threatening condition, which is as difficult to diagnose as it is to treat. Fortunately, it is rare, most commonly seen as a delayed complication of aortic reconstruction. Two types are recognized: primary and secondary. Primary fistulas occur de novo between the aorta and bowel, most commonly duodenum. Secondary fistulas occur between an aortic graft and segment of bowel. Diagnosis of AEF requires a high index of suspicion in patients who present with either signs of infection or gastrointestinal hemorrhage. Early diagnosis is essential for a successful outcome because of the lethal nature of AEF. Symptomatology can be varied but most often includes signs of infection and of gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans are the most useful tests to diagnose AEF. Treatment almost always requires excision of the infected graft and revascularization. Placement of an extra anatomic bypass, followed by graft excision, has been the usual treatment. Recent experience with in situ revascularization has shown that a variety of materials can be use for in situ reconstruction with good results. Morbidity and mortality rates still are high even in contemporary series. The mortality rate still is approximately 33%, but amputation rates have been reduced to less then 10%. Care of patients with AEF requires timely control of bleeding and infection followed by vascular reconstruction performed in a manor to minimize physiological stress. Copyright 2001 by W.B. Saunders Company
          Article 0 comments Cited 23 times – based on 0 reviews     Review now
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            Secondary arterioenteric fistulation--a systematic literature analysis.

            D Bergqvist, M Björck (2009)
            To analyze the problem of secondary arterioenteric fistulation, a rare but serious complication. A systematic literature review was performed searching for case reports as well as patients included in articles analyzing especially infectious complications. 332 individual cases and 1135 patients from papers on complications were identified. All types of surgery involving aorta and its branches could precede the complication, endovascular procedures included. The development of a fistula can occur at any time after primary surgery, the longest delay being 26 years. Bleeding was the dominating symptom with herald bleeding in more than half of the patients, infectious problems present in around one quarter. Diagnostic delay was typical, although decreasing over time. The mortality was high, lowest after axillobifemoral revascularization and aortic graft removal. The information in the articles is often heterogeneous and incomplete, and follow-up time is often too short. Mortality after fistulation seems to have decreased over time. Secondary arterioenteric fistula continues to be an extremely serious complication after surgery on aorta and its branches. Every effort must be made to arrive at a rapid diagnosis. The best therapeutic option seems to be axillobifemoral revascularization and subsequent graft removal, which however, requires haemodynamically stable patients. Endovascular repair may serve as a bridge to open surgery.
            Article 0 comments Cited 20 times – based on 0 reviews     Review now
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              Aortoduodenal fistulas after endovascular stent-graft repair of abdominal aortic aneurysms: single-center experience and review of the literature.

              Dimitrios Kiskinis, Athanasios Saratzis, Nikolaos Melas … (2008)
              To report a single-center experience with aortoduodenal fistula (ADF) after successful endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA). Five patients (all men; mean age 68.4 years, range 60-75) developed an ADF between 18 days to 1 year after successful EVAR using 3 types of commercially available endografts: 1 bifurcated Anaconda, 1 unibody Powerlink, and 3 EndoFit stent-grafts in a tubular (n=1) or aortomonoiliac configuration (n=2). The internal iliac artery was not occluded in any of the cases. Hematemesis and diffuse abdominal pain constituted the main symptoms leading to the diagnosis of ADF, which was confirmed on computed tomography. Infection was the etiology of the ADF in 3 patients; all underwent emergency surgical exploration, but 1 died in hospital; the other 2 have survived from 1 to 3 years after an emergency procedure. The other 2 ADFs developed in patients with large type I endoleaks; 1 patient died before surgery could be performed and the other one 18 hours after laparotomy. All stent-grafts were removed; none displayed any defects. ADF is a rare but dangerous complication of EVAR. The sequela may be primarily attributed to graft infection, as seen in this series. However, the exact pathogenesis of the pathology remains largely unknown. Prompt diagnosis and intervention are crucial to avoid a fatal outcome.
              Article 0 comments Cited 15 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Report Med
                Journal ID (publisher-id): CRIM
                Title: Case Reports in Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1687-9627
                ISSN (Electronic): 1687-9635
                Publication date (Print): 2011
                Publication date (Electronic): 29 December 2011
                Volume: 2011
                Electronic Location Identifier: 406730
                Affiliations
                Department of Health Services, Policy and Practice, Alpert Medical School, Brown University, Providence, RI 02912, USA
                Author notes

                Academic Editor: Gerald S. Supinski

                Article
                DOI: 10.1155/2011/406730
                PMC ID: 3254217
                PubMed ID: 22242028
                SO-VID: d4625440-f6a8-49a2-91e8-42c17ac22ecc
                Copyright © Copyright © 2011 T. Simon and E. Feller.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 1 August 2011
                Date accepted : 6 October 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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