Under the Radar: A Case Report of a Missed Aortoenteric Fistula

Author:

Briggs Blake1,Manthey David2

Affiliation:

1. University of South Alabama, Department of Emergency Medicine, Mobile, Alabama

2. Wake Forest University, Department of Emergency Medicine, Winston-Salem, North Carolina

Abstract

Introduction: An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report: Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion: Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.

Publisher

Western Journal of Emergency Medicine

Subject

Emergency Nursing,Emergency Medicine

Reference15 articles.

1. Keunen B, Houthoofd S, Daenens K, et al. A case of primary aortoenteric fistula: review of therapeutic challenges. Ann Vasc Surg. 2016;33:230.e5-230.e13.

2. Dossa CD, Pipinos II, Shepard AD, et al. Primary aortoenteric fistula: Part I. Ann Vasc Surg. 1994;8(1):113-20.

3. O’Mara C and Imbembo AL. Paraprosthetic-enteric fistula. Surgery. 1977;81(5):556-66.

4. Maltezos K, Bisdas T, Patelis N. Endovascular repair of aorto-enteric fistulae as a definitive treatment strategy. Vasc Dis Manag. 2020;17(3):46-50.

5. Pipinos II, Carr JA, Haithcock BE, et al. Secondary aortoenteric fistula. Ann Vasc Surg. 2000;14(6):688-96.

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