Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature

Abstract

BACKGROUND Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping. CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF. CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.

Case report – Computed tomography diagnosis of an abdominal aortic aneurysm complicated with primary aortoduodenal fistula

“…With advances in endoscopic techniques and equipment, large clips for the closure of vascular-enteric fistulas have come forward. Thus, clipping of fistulas with esophagogastroduodenoscopy has now become feasible, and the clipping of aorta-duodenal fistulas might be the next step forward [19] .…”

Chicken Bone Ingestion Leads to Aortoesophageal Fistula With Catastrophic Bleeding

“…11 Endoscopic treatment options to control bleeding have included covered esophageal stents, and 1 study reported the effective use of endoclips to manage AEF. [12][13][14] Such endoscopic interventions may serve as a bridge but may be done as definitive therapy in patients with advanced age, multiple comorbidities, and poor surgical candidates where endoscopic and radiological embolization may be the best alternatives. 15,16 In our case, placement of endoclips did not prevent the massive and lethal bleeding that ensued, reinforcing the need for emergent surgical readiness and intervention in any case of suspected AEF.…”