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

Abstract

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.

Aorto‐duodenal Fistula: Multidetector Computed Tomography and Gastroduodenoscopy Findings of a Rare Cause of Upper Gastrointestinal Hemorrhage

“…From our research of the literature, diagnostic suspicion of aorto‐enteric fistula by MDCT is assumed on the basis of the interruption of the aortic wall with presence of duodenal gas situated in close contact with the aorta. We have not found MDCT images like those of our case, characterized by the presence of gas in the lumen of the aorta 4–14 …”

Aortoduodenal fistula after abdominal aortic aneurism resection: Two case reports

“…In some cases, clinical signs were not so clear, so patients had normal arterial pressure, pulse, normal signs on pulmonary and heart systems, but with light drop in hemoglobin and hematocrit values. Katsinelos et all [9] in 2005 said that their all patients with AEF despite presenting with classic "herald bleeding" died as a result of delayed operative intervention. Japanese authors [10,6] also had postmortem autopsy and identification of the cause of sudden death with massive bleeding.…”

“…But, frequently, in cases of ADF EGDS finding were negative and it can't find place of bleeding. [9,11] Physicians, can find duodenum full of coagulum and fresh blood, but couldn't identify a origin of intestinal bleeding, and communication between aorta and intestine was not detected. [6] Nevertheless, most of AEF are duodenal (81%) in the third and fourth portions,and complete examination of the duodenum is essential.…”

“…[6] If this process destruct bowel wall only, aortoenteric erosion became rather than fistula and lots of air bubbles can find on MSCT around the aorta and this is a specific sign for the diagnosis of an aortic graft infection. [9,1] MSCT angiography with contrast is also very important diagnostic procedure and can be performed in an emergent situationand has been recommended as an initial diagnostic test for AEF. But, aMSCT of the upper abdomen with bolus contrast often can show no signs of an aortoenteric fistula.…”

Secondary aortoduodenal fistula: don’t believe the hype!

“…L'infection de prothèse est présente de façon quasi systéma-tique lors de FAE [6,7]. L'endoscopie gastrique peut être une alternative intéressante pour porter le diagnostic : elle ne peut généralement pas identifier clairement la fistule, mais peut retrouver des signes indirects comme une ulcération entourée de muqueuse saine ou un aspect de tumeur de la sous-muqueuse [8,9]. En revanche, elle prend tout son inté-rêt lorsqu'elle objective un autre saignement actif, d'origine digestive [5].…”