Critical gastrointestinal bleed due to secondary aortoenteric fistula

Abstract

Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS)

“…The single mortality in our study involved a patient that developed an aorto-esophageal fistula secondary to SEMS placement. Aorto-esophageal and aorto-enteric fistulas are known complications of vascular surgery involving the aorta, such as those utilizing endovascular stents, where major hemorrhage is often preceded by a smaller herald bleed [30][31][32]. The radial traction of the SEMS may erode through the wall of the esophagus or induce inflammation and result in a fistulous tract between the aorta and esophagus.…”

A patient with lower gastrointestinal bleeding: common history, very uncommon cause, minimally invasive treatment

“…For primary AEF, atherosclerosis is the most common risk factor. Other underlying conditions may be infections (such as syphilis or tuberculosis), intestinal malignancies, radiation, or mechanical stress [1].…”

Gastrointestinal bleeding caused by false symptomatic infrarenal abdominal aortic aneurysm

“…Кроме этого, аневризма брюшного отдела аорты может пенетрировать в желудок, тощую, подвздошную или сигмовидную кишку. Другие симптомы встречаются реже, это боль в животе, пальпируемое пульсирующее образование передней брюшной стенки, боль в спине, мелена, лихорадка или обморок [2][3][4][5][6].…”