Aortoenteric fisulta: Difference between revisions
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==Workup== | ==Workup== | ||
'''* If suspicion high, involve vascular surgery early''' | |||
* CBC | * CBC | ||
* Chem 10 | * Chem 10 | ||
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* 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== | ||
Revision as of 20:38, 25 March 2015
Background
A fistula formed between aorta and intestines, can be primary or secondary (often due to AAA repair)
- Can form fistula anytime within life of AAA graft repair
Incidence: The annual incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
Clinical Features
- Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients
- Low grade fever,
- abd pain,
- Back pain,
- h/o AAA graft
- BRBPR
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Workup
* If suspicion high, involve vascular surgery early
- CBC
- Chem 10
- Type and Cross
- PT/INR/PTT
- chest xray for pre-op, if patient stable
- EKG for pre-op
- CTA of abdomen/pelvis, highly sensitive, if patient stable
- Patient may need gastroduodenal endoscopy