Aortoenteric fisulta: Difference between revisions
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==Background== | ==Background== | ||
*Fistula formed between aorta and intestines | |||
* Can form fistula anytime within life of AAA graft repair | **Can be primary or secondary (often due to AAA repair) | ||
< | **Can form fistula anytime within life of AAA graft repair | ||
*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% | |||
==Clinical Features== | ==Clinical Features== | ||
* Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients | *Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients | ||
*Low grade fever | *Low grade fever | ||
*abd pain | *abd pain | ||
*Back pain | *Back pain | ||
* | *H/o AAA graft | ||
*BRBPR | *BRBPR | ||
| Line 17: | Line 19: | ||
==Workup== | ==Workup== | ||
'''* If suspicion high, involve vascular surgery early''' | '''* If suspicion high, involve vascular surgery early''' | ||
* CBC | *CBC | ||
* Chem 10 | *Chem 10 | ||
* Type and Cross | *Type and Cross | ||
* PT/INR/PTT | *PT/INR/PTT | ||
* | *Blood culture if fever - high risk for infections with secondary fistulas (ie grafts) | ||
* EKG for pre-op | *CXR for pre-op, if patient stable | ||
* CTA of abdomen/pelvis, highly sensitive, if patient stable | *EKG for pre-op | ||
* Patient may need gastroduodenal endoscopy | *CTA of abdomen/pelvis, highly sensitive, if patient stable | ||
*Patient may need gastroduodenal endoscopy | |||
==Management== | ==Management== | ||
*Surgical Intervention | |||
**Transfer if not available | |||
==Disposition== | ==Disposition== | ||
*Admission | |||
==External Links== | ==External Links== | ||
Revision as of 04:37, 5 April 2015
Background
- 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
- Involves the duodenum (ADF) in most cases[1]
- 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
- Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
- CXR for pre-op, if patient stable
- EKG for pre-op
- CTA of abdomen/pelvis, highly sensitive, if patient stable
- Patient may need gastroduodenal endoscopy
Management
- Surgical Intervention
- Transfer if not available
Disposition
- Admission
External Links
Sources
- ↑ 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.