Aortoenteric fisulta - Revision history

Ostermayer: Marked this version for translation

2026-01-06T20:34:22Z

Marked this version for translation

← Older revision		Revision as of 20:34, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	*Fistula formed between aorta and intestines		*Fistula formed between aorta and intestines
	**Can be primary or secondary (often due to [[Special:MyLanguage/AAA\|AAA]] repair)		**Can be primary or secondary (often due to [[Special:MyLanguage/AAA\|AAA]] repair)
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	==Clinical Features==		==Clinical Features== <!--T:3-->

			<!--T:4-->
	*Classic triad: [[Special:MyLanguage/abdominal pain\|abdominal pain]], [[Special:MyLanguage/GI bleeding\|GI bleeding]] and pulsatile abdominal mass		*Classic triad: [[Special:MyLanguage/abdominal pain\|abdominal pain]], [[Special:MyLanguage/GI bleeding\|GI bleeding]] and pulsatile abdominal mass
	**Present in 23% of patients		**Present in 23% of patients
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:5-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:6-->

			<!--T:7-->
	[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]		[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]
	[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png\|thumb\|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]		[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png\|thumb\|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]
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	==Management==		==Management== <!--T:8-->

			<!--T:9-->
	*[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]		*[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]
	*Transfuse [[Special:MyLanguage/pRBCs\|pRBCs]] as needed		*Transfuse [[Special:MyLanguage/pRBCs\|pRBCs]] as needed
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	==Disposition==		==Disposition== <!--T:10-->

			<!--T:11-->
	*Admission		*Admission


	==External Links==		==External Links== <!--T:12-->


	==References==		==References== <!--T:13-->

			<!--T:14-->
	<references/>		<references/>

			<!--T:15-->
	[[Category:GI]]		[[Category:GI]]
	[[Category:Vascular]]		[[Category:Vascular]]
	[[category:Surgery]]		[[category:Surgery]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:40:09Z

Prepared the page for translation

← Older revision		Revision as of 21:40, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*Fistula formed between aorta and intestines		*Fistula formed between aorta and intestines
	**Can be primary or secondary (often due to [[AAA]] repair)		**Can be primary or secondary (often due to [[Special:MyLanguage/AAA\|AAA]] repair)
	**Can form fistula anytime within life of [[AAA]] graft repair		**Can form fistula anytime within life of [[Special:MyLanguage/AAA\|AAA]] graft repair
	***Higher risk with recent graft placement		***Higher risk with recent graft placement
	*Involves the duodenum (ADF) in most cases<ref>Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.</ref>		*Involves the duodenum (ADF) in most cases<ref>Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.</ref>
	*Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%		*Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
	*Mortality of 100% if left untreated		*Mortality of 100% if left untreated


	==Clinical Features==		==Clinical Features==
	*Classic triad: [[abdominal pain]], [[GI bleeding]] and pulsatile abdominal mass
			*Classic triad: [[Special:MyLanguage/abdominal pain\|abdominal pain]], [[Special:MyLanguage/GI bleeding\|GI bleeding]] and pulsatile abdominal mass
	**Present in 23% of patients		**Present in 23% of patients
	*Low grade [[fever]]		*Low grade [[Special:MyLanguage/fever\|fever]]
	*[[Abdominal pain]]		*[[Special:MyLanguage/Abdominal pain\|Abdominal pain]]
	*[[Back pain]]		*[[Special:MyLanguage/Back pain\|Back pain]]
	*History of [[AAA]] graft		*History of [[Special:MyLanguage/AAA\|AAA]] graft
	*[[BRBPR]] or [[melena]]		*[[Special:MyLanguage/BRBPR\|BRBPR]] or [[Special:MyLanguage/melena\|melena]]
	**Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed		**Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{UGIB DDX}}		{{UGIB DDX}}
			<translate>
			</translate>
	{{Lower GI bleeding DDX}}		{{Lower GI bleeding DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]		[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]
	[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png\|thumb\|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]		[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png\|thumb\|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]
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	*PT/INR/PTT		*PT/INR/PTT
	*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)		*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
	*[[Aortic ultrasound]] and [[FAST exam]] to assess for AAA and Free Fluid		*[[Special:MyLanguage/Aortic ultrasound\|Aortic ultrasound]] and [[Special:MyLanguage/FAST exam\|FAST exam]] to assess for AAA and Free Fluid
	*[[CXR]] for pre-op, if patient stable		*[[Special:MyLanguage/CXR\|CXR]] for pre-op, if patient stable
	*[[ECG]] for pre-op		*[[Special:MyLanguage/ECG\|ECG]] for pre-op
	*CTA of abdomen/pelvis, highly sensitive, if patient stable		*CTA of abdomen/pelvis, highly sensitive, if patient stable
	*Patient may need gastroduodenal endoscopy		*Patient may need gastroduodenal endoscopy


	==Management==		==Management==
	*[[Fluid resuscitation]]
	*Transfuse [[pRBCs]] as needed		*[[Special:MyLanguage/Fluid resuscitation\|Fluid resuscitation]]
			*Transfuse [[Special:MyLanguage/pRBCs\|pRBCs]] as needed
	*Surgical Intervention		*Surgical Intervention
	**Transfer if not available		**Transfer if not available


	==Disposition==		==Disposition==

	*Admission		*Admission


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

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	[[Category:Vascular]]		[[Category:Vascular]]
	[[category:Surgery]]		[[category:Surgery]]
			</translate>

Rossdonaldson1: /* Evaluation */

2021-07-08T21:48:15Z

Evaluation

← Older revision		Revision as of 21:48, 8 July 2021
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	==Evaluation==		==Evaluation==
	[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]		[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]
			[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png\|thumb\|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]
	'''If suspicion high, involve vascular surgery early'''		'''If suspicion high, involve vascular surgery early'''
	*CBC		*CBC

Rossdonaldson1: /* Evaluation */

2021-07-08T21:43:09Z

Evaluation

← Older revision		Revision as of 21:43, 8 July 2021
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	==Evaluation==		==Evaluation==
			[[File:AortoEntericFistulaDissectionMark.png\|thumb\|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]
	'''If suspicion high, involve vascular surgery early'''		'''If suspicion high, involve vascular surgery early'''
	*CBC		*CBC

ClaireLewis at 19:14, 29 September 2019

2019-09-29T19:14:50Z

← Older revision		Revision as of 19:14, 29 September 2019
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	*Low grade [[fever]]		*Low grade [[fever]]
	*[[Abdominal pain]]		*[[Abdominal pain]]
	*Back pain		*[[Back pain]]
	*History of [[AAA]] graft		*History of [[AAA]] graft
	*[[BRBPR]] or [[melena]]		*[[BRBPR]] or [[melena]]
	*Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed		**Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Management==		==Management==
	*Fluid resuscitation		*[[Fluid resuscitation]]
	*Transfuse [[pRBCs]] as needed		*Transfuse [[pRBCs]] as needed
	*Surgical Intervention		*Surgical Intervention
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	[[Category:GI]]		[[Category:GI]]
	[[Category:Vascular]]		[[Category:Vascular]]
			[[category:Surgery]]

Rossdonaldson1: /* Differential Diagnosis */

2018-09-23T22:27:21Z

Differential Diagnosis

← Older revision		Revision as of 22:27, 23 September 2018
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{UGIB DDX}}
	{{Lower GI bleeding DDX}}		{{Lower GI bleeding DDX}}

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T17:11:36Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 17:11, 24 July 2016
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	{{Lower GI bleeding DDX}}		{{Lower GI bleeding DDX}}

	==~~Diagnosis~~==		==Evaluation==
	'''If suspicion high, involve vascular surgery early'''		'''If suspicion high, involve vascular surgery early'''
	*CBC		*CBC

Neil.m.young: Text replacement - "Ultrasound: FAST" to "FAST exam"

2016-07-18T13:26:57Z

Text replacement - "Ultrasound: FAST" to "FAST exam"

← Older revision		Revision as of 13:26, 18 July 2016
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	*PT/INR/PTT		*PT/INR/PTT
	*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)		*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
	*[[Aortic ultrasound]] and [[~~Ultrasound:~~ FAST]] to assess for AAA and Free Fluid		*[[Aortic ultrasound]] and [[FAST exam]] to assess for AAA and Free Fluid
	*[[CXR]] for pre-op, if patient stable		*[[CXR]] for pre-op, if patient stable
	*[[ECG]] for pre-op		*[[ECG]] for pre-op

Neil.m.young: Text replacement - "Ultrasound: Aorta" to "Aortic ultrasound"

2016-07-18T03:20:26Z

Text replacement - "Ultrasound: Aorta" to "Aortic ultrasound"

← Older revision		Revision as of 03:20, 18 July 2016
Line 28:		Line 28:
	*PT/INR/PTT		*PT/INR/PTT
	*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)		*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
	*[[~~Ultrasound: Aorta~~]] and [[Ultrasound: FAST]] to assess for AAA and Free Fluid		*[[Aortic ultrasound]] and [[Ultrasound: FAST]] to assess for AAA and Free Fluid
	*[[CXR]] for pre-op, if patient stable		*[[CXR]] for pre-op, if patient stable
	*[[ECG]] for pre-op		*[[ECG]] for pre-op

Neil.m.young at 15:50, 18 May 2016

2016-05-18T15:50:44Z

← Older revision		Revision as of 15:50, 18 May 2016
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	==Diagnosis==		==Diagnosis==
	'''*If suspicion high, involve vascular surgery early'''		'''If suspicion high, involve vascular surgery early'''
	*CBC		*CBC
	*Chem 10		*Chem 10
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	*[[Ultrasound: Aorta]] and [[Ultrasound: FAST]] to assess for AAA and Free Fluid		*[[Ultrasound: Aorta]] and [[Ultrasound: FAST]] to assess for AAA and Free Fluid
	*[[CXR]] for pre-op, if patient stable		*[[CXR]] for pre-op, if patient stable
	*[[~~EKG~~]] for pre-op		*[[ECG]] for pre-op
	*CTA of abdomen/pelvis, highly sensitive, if patient stable		*CTA of abdomen/pelvis, highly sensitive, if patient stable
	*Patient may need gastroduodenal endoscopy		*Patient may need gastroduodenal endoscopy