Revista de Gastroenterología de México Revista de Gastroenterología de México
Rev Gastroenterol Mex 2018;83:194-5 - Vol. 83 Num.2 DOI: 10.1016/j.rgmxen.2018.05.002
Clinical image in Gastroenterology
Aortoenteric fistula: A worrisome endoscopic finding
Fístula aortoentérica: un hallazgo endoscópico preocupante
H. Fanga,, , A. Rubio-Tapiab, N. Coelho-Prabhub
a Departamento de Medicina Interna, Mayo Clinic, Rochester, Minnesota, United States
b División de Gastroenterología y Hepatología, Mayo Clinic, Rochester, Minnesota, United States

Secondary aortoenteric fistulas are an uncommon and life-threatening condition that develop in the setting of a predisposing etiology, such as a prior aortic graft. Aortoduodenal fistulas are the most common connection, representing from 65.4 to 77.5% of cases.1 Helical CT scans are highly sensitive for detecting abnormalities consistent with aortoduodenal fistulas, with a previous study showing a sensitivity of 93%.2 Endoscopy can aid in confirming the diagnosis, but has a lower sensitivity for detecting aortoenteric fistulas (20 to 25%).3,4 Therefore, upper endoscopy should be performed after suspicious findings are first noted on CT imaging.

A 78-year-old man, with a significant past medical history of aortobifemoral bypass graft performed 6 years earlier, arrived at the emergency department with sudden-onset fever, chills, abdominal pain, and hematochezia. Abdominal CT imaging revealed soft tissue and fluid stranding around the proximal aortic graft, with tethering to the adjacent small bowel (fig. 1).

Figure 1.
(0.14MB).

Abdominal CT scan showing the proximal aortic graft in close relation to the wall of the small bowel.

An emergent esophagogastroduodenoscopy was performed and revealed a large foreign body in the third part of the duodenum, with endoscopic confirmation of an aortoenteric fistula (fig. 2).

Figure 2.
(0.08MB).

Esophagogastroduodenoscopy confirmed aortoenteric fistula.

The patient subsequently underwent explantation of the infected graft, with insertion of a cryopreserved graft and primary closure of his duodenotomy.

Intermittent gastrointestinal (GI) bleeding is the most common preceding symptom in aortoenteric fistulas, but 45% of patients with bleeding present with massive GI bleeding.3

Thus, aortoenteric fistula should be suspected in all patients presenting with lower GI bleeding and a history of aortic repair.

Financial disclosure

No financial support was received in relation to this article.

Author contributions

Hongfei Fang performed the literature review and drafted the manuscript.

Alberto Rubio Tapia reviewed both the radiologic imaging and the manuscript.

Nayantara Coelho Prabhu supervised the manuscript preparation and is the article guarantor.

Ethical disclosuresProtection of human and animal subjects

The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.

Confidentiality of data

The authors declare that no patient data appears in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflict of interest

The authors declare that there is no conflict of interest.

References
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S.K. Kakkos,C.D. Bicknell,I.A. Tsolakis
Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis
Eur J Vasc Endovasc Surg, 52 (2016), pp. 770-786 http://dx.doi.org/10.1016/j.ejvs.2016.09.014
2
P.A. Armstrong,M.R. Back,J.S. Wilson
Improved outcomes in the recent management of secondary aortoenteric fistula
J Vasc Surg, 42 (2005), pp. 660-666 http://dx.doi.org/10.1016/j.jvs.2005.06.020
3
C.L. Deijen,Y.M. Smulders,H.M. Coveliers
The Importance of Early Diagnosis and Treatment of Patients with Aortoenteric Fistulas Presenting with Herald Bleeds
Ann Vasc Surg, 36 (2016), pp. 28-34 http://dx.doi.org/10.1016/j.avsg.2016.03.028
4
F.M. Hughes,D. Kavanagh,M. Barry
Aortoenteric fistula: A diagnostic dilemma
Abdom Imaging, 32 (2007), pp. 398-402 http://dx.doi.org/10.1007/s00261-006-9062-7

Please cite this article as: Fang H, Rubio-Tapia A, Coelho-Prabhu N. Fístula aortoentérica: un hallazgo endoscópico preocupante. Revista de Gastroenterología de México. 2018;83:194–195.

Corresponding author. Department of Internal Medicine, 200 First Street SW, Rochester, Minnesota 55905. (H. Fang fang.hongfei@mayo.edu)
Rev Gastroenterol Mex 2018;83:194-5 - Vol. 83 Num.2 DOI: 10.1016/j.rgmxen.2018.05.002