Detection of aortoenteric fistula with helical CT

Puvaneswary, M; Cuganesan, Ramesh

doi:10.1046/j.1440-1673.2003.01107.x

Cited by 15 publications

(7 citation statements)

References 8 publications

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“…Bleeding arising from a point distal to the second part of the duodenum in the absence of a proximal lesion suggests an AEF. 11 Computed tomography scanning is also useful for confirming the presence of an abnormal communication between the prosthetic graft and the gastrointestinal tract or for showing extraluminal gas in the periaortic region. 12,13 Angiography may complement upper endoscopy and CT, providing information that could alter the surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Secondary Aortoduodenal Fistula with a Fatal Outcome: Report of Six Cases

Katsinelos¹,

Paroutoglou

Papaziogas

et al. 2005

Surg Today

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Secondary aortoenteric fistulas (AEFs) are a well-known but uncommon cause of gastrointestinal hemorrhage. They usually occur secondary to reconstructive surgery of an abdominal aneurysm. We report six cases of secondary aortoduodenal fistulas, involving patients who, despite presenting with classic "herald bleeding," died as a result of delayed operative intervention. We also discuss the pathogenesis, clinical presentation, and diagnosis of AEFs, emphasizing the value of clinical suspicion and negative endoscopy in establishing the diagnosis and the need for early operative intervention.

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Section: Discussionmentioning

confidence: 99%

Secondary Aortoduodenal Fistula with a Fatal Outcome: Report of Six Cases

Katsinelos¹,

Paroutoglou

Papaziogas

et al. 2005

Surg Today

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“…Most patients present with an initial episode of bleeding (herald bleed) followed by catastrophic hemorrhage as occurred in our case after a variable period of time. The difficulty in diagnosis of AEF was discussed in several literatures [1,3,4], and this is highlighted in our case. Although gastroduodenoscopy is important to exclude other source of bleeding, it has a low sensitivity to make the diagnosis of AEF.…”

Section: Discussionmentioning

confidence: 65%

“…Secondary fistulae develop after aortic intervention and typically involve a proximal suture line and/or prosthetic graft material[1]. It is a rare complication following aortic graft surgery, with a reported incidence between 0.36-4% of patients who have undergone open aortic surgery[2,3]. Here we report a case with this rare complication with typical herald bleeding.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal bleeding after aortic surgery: a case report

Shitara

Wada

2009

Cases Journal

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IntroductionAn aortoenteric fistula is a communication between the aorta and an adjacent loop of the bowel. Here we report a case with this rare complication with typical herald bleeding.Case reportA 66-year-old man underwent elective repair of a large supra-renal abdominal aortic aneurysm and returned 6 months later to our clinic after experiencing a melena with hematochezia. The source of bleeding could not be identified by gastroscopy but the following day he vomited a large volume of blood, rapidly became haemodynamically unstable and died of hypotensive shock. A CT scan on the same day showed an increasing area of low-density soft tissue around the graft wall compared with the previous CT scan images obtained initially after the aortic repair. An aortoenteric fistula was confirmed by autopsy.ConclusionIn patients that underwent abdominal aortic surgery, both the occurrence of herald bleeding and CT findings of increasing para graft soft tissue might play a crucial role in early detection of aortoenteric fistula.

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“…Some authors recommend the omission of oral contrast with the abdominal CT scan in order to demonstrate contrast extravasation from the aorta into the bowel lumen [10]. In case of a negative CT scan, additional studies-including magnetic resonance imaging (MRI), gastroenteric endoscopy, In-labeled white blood AEF aortoenteric fistula cell scanning, red blood cell scintigraphy, positron emission tomography-are alternative diagnostic examinations that can be utilized.…”

Section: Discussionmentioning

confidence: 99%

A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease

Pace

Savino

Rasoini³

et al. 2010

Intern Emerg Med

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Case presentationDr. Del Pace: A 72-year-old man with history of coronary and peripheral artery disease was admitted to this hospital with fever, fatigue and loss of weight. He had hypertension, type 2 diabetes mellitus and hyperlipidemia. He suffered from an ischemic cardiomyopathy with a low ejection fraction (33%). Fifty years prior he had undergone subtotal gastroresection for peptic ulcer. Seventeen years prior to this current admission (PTA), he had an aortobifemoral bypass grafting for symptomatic peripheral artery disease, and 8 years prior he had a myocardial infarction. Three vessel coronary disease was detected and coronary-artery bypass grafting had been carried out.One year PTA, he experienced an episode of sustained ventricular tachycardia, treated with stenting of the anterior descending coronary artery, followed by an internal cardiac defibrillator (ICD) implantation. Ten months PTA, he had a massive enteric bleeding complicated by hemorrhagic shock. A colonoscopy revealed ulcerated cecal angiodysplasia that was treated with an application of metallic clips.During the following months, he was admitted several times for sideropenic anemia without evidence of acute gastrointestinal bleeding, and iron therapy was administrated. Two colonoscopies were performed but no source of active bleeding was detected.Two months PTA, he developed a low-grade fever resistent to a 2-week course of antibiotic therapy with levofloxacin.Laboratory tests showed a normocytic anemia (8.1 g/dL) with normal levels of B12 and folic acid, with low levels of sideremia (13 lg/dL), and a normal haptoglobin.An esophagogastroduodenoscopy was normal. Neoplastic markers (NSE, CA 125, CEA, were all in the normal range. Antinuclear antibody, ANCA, rheumatoid factor were negative as well as immunofixation in serum and urine.A computed tomography (CT scan) of the abdomen with contrast material confirmed ceacum angiodysplasia, but did not reveal active enteral bleeding. Transesophageal echocardiography was performed, and a vegetation on the ICD catheter was found. One blood culture was positive for Streptococcus intermedius. Treatment with amoxicillin was started, and during the hospital stay, the fever disappeared. Removal of the pacemaker was suggested, but the patient refused it. After discharge, he completed a 4-week cycle of antibiotic therapy, but after 1 week of withdrawal, fever developed again with malaise, fatigue and weight loss. He was readmitted to this hospital.On examination, the patient appeared in mild distress. He had low-grade fever (37.5°C). The Blood pressure was 100/50 mmHg, pulse rate 70 beats/min and oxygen saturation 98% while he was breathing ambient air. A grade 2/6

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Detection of aortoenteric fistula with helical CT

Abstract: We describe a case of a patient with symptoms suggestive of secondary aortoenteric fistula (AEF). Extravasation of contrast medium from the aorta into the lumen of the small bowel was definitive evidence of AEF. The role of abdominal CT performed without oral contrast is discussed.

Cited by 15 publications

References 8 publications

Secondary Aortoduodenal Fistula with a Fatal Outcome: Report of Six Cases

Secondary Aortoduodenal Fistula with a Fatal Outcome: Report of Six Cases

Gastrointestinal bleeding after aortic surgery: a case report

A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease

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