Primary Aorto-duodenal Fistula: A Rare but Potentially Fatal Cause of Gastrointestinal Bleeding

Barba, Elena Romera; Pérez, Ainhoa Sánchez; Puche, Julia Bertelli; Pérez, Casanova; Rojas, José Luis Vázquez

doi:10.1016/j.cireng.2014.12.008

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…30-day mortality was 40%, which doubled at 6 months. This supports the conclusion that EVAR should be considered only as bridging measure prior to definitive surgical repair [ 14 ]. An exception could be in the palliative setting where endovascular repair can be the only definite procedure [ 1 ].…”

Section: Discussionsupporting

confidence: 83%

“…Ultrasound, magnetic resonance imaging and tagged white cell scans are seldom useful. Angiography requires a flow of more than 0.5 mL/min and only detects 30% of actively bleeding fistulae [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…If primary repair of the small bowel is not possible, then resection and anastomosis is recommended. Primary suturing of small defects is appropriate, but omental flap interposition or duodenal switch are recommended for larger defects as there is a high risk of recurrence with suturing alone [ 11 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…An exception could be in the palliative setting where endovascular repair can be the only definite procedure [ 1 ]. As the risk of infection is high, patients require antibiotic cover following EVAR [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

Dimech

Sammut

Cortis

et al. 2018

International Journal of Surgery Case Reports

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HighlightsPrimary arterio-enteric fistula between the common iliac artery and duodenum is rare and radiotherapy is one aetiological factor.Resuscitation is mandatory on presentation with acute massive haematemesis secondary to ilio-duodenal fistula.Interventional radiology can be successfully deployed mainly in the form of stenting or coil embolisation.Follow-up open fistula repair is recommended as a definitive measure to prevent a late recurrent haemorrhagic episode.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

Dimech

Sammut

Cortis

et al. 2018

International Journal of Surgery Case Reports

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“…ность ИПП в предотвращении ЖКК у пациентов с ИБС, складывается впечатление, что роль противоязвенной терапии в предотвращении геморрагий у стабильных пациентов ниже по сравнению с более тяжелыми пациентами с ОКС. Так, в исследовании COGENT [17], в которое почти 1/2 больных включались сразу после перенесенного ОКС, прием ИПП ассоциировался со снижением риска явных кровотечений из верхних отделов ЖКТ на 87% (отношение шансов -ОШ 0,13; 95% доверительный интервал -ДИ 0,03-0,56; p=0,001), тогда как в исследовании COMPASS PPI [18] применение ИПП привело лишь к 48% снижению риска ЖКК (ОШ 0,52; 95% ДИ 0,28-0,94; p=0,03). Вероятно, у пациентов со стабильной ИБС большой вклад в патогенез поражения ЖКТ могут вносить хронические состояния, ухудшающие кровоснабжение слизистой оболочки и, соответственно, замедляющие ее репарацию.…”

Section: ââåäåíèåunclassified

Upper gastrointestinal bleeding in patients with stable coronary artery disease (registry of antithrombotic therapy “REGATТA” results)

Шахматова

Комаров

Korobkova

et al. 2020

Terapevticheskii arkhiv

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Introduction.Upper gastrointestinal (UGI) bleeding is a common complication of antiplatelet therapy. Data from real clinical practice that characterize the range of risk factors for UGI bleeding, prophylactic proton pump inhibitors (PPIs) therapy, bleeding frequency and their long-term effects in patients with stable coronary artery disease (CAD) are limited. Aim.To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding. Materials and methods.934 patients with stable CAD (median age 61 [5368] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 612 months after elective PCI. PPIs were prescribed in 28.3% of cases. Results.The median follow-up was 2.5 [1.15.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year. Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.911.8;p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.716.6;p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure HF (OR 6.1; 2.316.0;p=0.0002), AAA (OR 9.3; 2.534.2;p=0.0008) and APA (OR 2.3; 0.985.5;p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding 1.4%;p0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate 31.4%, mortality rate 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7107.9;p0.0001), APA (OR 4.2; 1.0317.2;p=0.045) and HF (OR 34.5; 8.5140.6;p0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died. Conclusion.In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.

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Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

Lin

Tsai

Chang

et al. 2018

BMC Cardiovasc Disord

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BackgroundPrimary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate.Case presentationWe report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta.ConclusionsA timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.

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Primary Aorto-duodenal Fistula: A Rare but Potentially Fatal Cause of Gastrointestinal Bleeding

Cited by 5 publications

References 11 publications

Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management

Upper gastrointestinal bleeding in patients with stable coronary artery disease (registry of antithrombotic therapy “REGATТA” results)

Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

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