Aortoenteric fisulta: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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*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--> | ||
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*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--> | ||
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==Evaluation== | ==Evaluation== <!--T:6--> | ||
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[[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--> | ||
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*[[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--> | ||
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*Admission | *Admission | ||
==External Links== | ==External Links== <!--T:12--> | ||
==References== | ==References== <!--T:13--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Vascular]] | [[Category:Vascular]] | ||
[[category:Surgery]] | [[category:Surgery]] | ||
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Latest revision as of 20:34, 6 January 2026
Background
- Fistula formed between aorta and intestines
- 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%
- Mortality of 100% if left untreated
Clinical Features
- Classic triad: abdominal pain, GI bleeding and pulsatile abdominal mass
- Present in 23% of patients
- Low grade fever
- Abdominal pain
- Back pain
- History of AAA graft
- BRBPR or melena
- Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed
Differential Diagnosis
Upper gastrointestinal bleeding
- Peptic ulcer disease (most common cause)
- Gastritis/esophagitis
- Gastric/esophageal varices
- Mallory-Weiss tear
- Malignancy
- Aortoenteric fisulta
- Boerhaave
- Dieulafoy's lesion
- Angiodysplasia
- Hemobilia
- Hemorrhagic gastritis, EtOH
- Celiac disease
- Dengue
- Other intrabdominal bleeds
- Lower GI bleeding
- Hemorrhagic pancreatitis
- Splenic rupture
- Subcapsular cavernous hemangiomas
- Peliosis hepatis
Mimics of GI Bleeding
- Hemoptysis
- Vaginal/Urethra bleeding
- ENT bleeding
- Dietary (Iron, bismuth, beets)
- Swallowed maternal blood (in neonate)
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
Evaluation
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)
- Aortic ultrasound and FAST exam to assess for AAA and Free Fluid
- CXR for pre-op, if patient stable
- ECG for pre-op
- CTA of abdomen/pelvis, highly sensitive, if patient stable
- Patient may need gastroduodenal endoscopy
Management
- Fluid resuscitation
- Transfuse pRBCs as needed
- Surgical Intervention
- Transfer if not available
Disposition
- Admission
External Links
References
- ↑ 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.