Primary aorto-enteric fistula

Abstract

HighlightsAorto-enteric fistulae are a rare cause of upper GI haemorrhage.Patient presented to A&E with an acute upper GI bleed and abdominal pain.Upper GI endoscopy inconclusive and too unstable for CT.Found to have a primary aorto-duodenal fistula secondary to retroperitoneal metastases.

Fístula aorto-duodenal primaria

“…En la mayoría de los casos se presenta un sangrado centinela que precede a un sangrado masivo exanguinante, pudiendo existir entre ambos un intervalo de horas a meses, pero en la mitad de los casos es de más de 24 h, de modo que puede dar tiempo para su control 1 . Por tanto, debiera ser considerado el diagnóstico de una FAEP frente a una hemorragia gastrointestinal sin causa aparente 5,7,10 . Es importante considerar en estos casos que el rendimiento de la endoscopía digestiva alta es inferior al 25%, porque la fístula se localiza habitualmente en el duodeno distal 1 .…”

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

“…‘Herald’ or ‘premonitory’ haemorrhage is a very important aspect of the clinical picture associated with primary AEFs. A ‘Herald bleed’ is an initial bleeding episode that precedes the catastrophic exsanguination where the bleeding is small enough that it is temporarily sealed off through thrombus formation 4. This then progresses to expansion of the fistula and dislodgement of the thrombus due to the high blood pressure within the aorta leading to the massive haemorrhage.…”

“…PAEF, when left untreated is fatal in 100% of cases 4. The mortality rate is 74% if surgical intervention is delayed until a catastrophic bleed 15.…”

“…In contrast, PAEF is rare, and has an incidence of 0.04%–0.07% in the general population and 0.69%–2.36% of patients with an abdominal aortic aneurysm (AAA), as reported in a large autopsy study 3. Aortoduodenal fistulae are the most common type (~60%) due to the close relationship of the duodenum (particularly the D3 and D4, as they are attached to the retroperitoneum) with the underlying abdominal aorta 4. Less frequently, PAEF does occur between the abdominal aorta and other portions of the alimentary tract including proximal small bowel, colon and oesophagus 5 6…”

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].…”