aortoenteric fistula: fear it

13 Oct

QUICK PEARLS:

Aortoenteric fistula: a communication between the aorta and the GI tract

consider in anyone with a GI bleed and a history of aortic surgery.

Can involve any part of the bowel but 75% involve the third part of the duodenum.

Mean time to presentation from surgical date is 32 months, but can run the gamut.

 

Can be primary (from AAA, but this is rare), but often related to aortic graft

 

Herald Bleeds

  • often have self-limited “herald bleeds”, can be intermittent
  • Stops from vasospasm or thrombus formation
  • Followed by massive GI bleed over the next month; 30% of these are within next 6 hours

 

DIAGNOSIS:

  • Conventional CT
  • CTA (most sensitive with “detection rate” of 61%)
  • EGD (25-62.5% or primary fistulas are identified)
  • Laparotomy

 

TREATMENT OPTIONS:

  • Endovascular stent for those than cannot tolerate surgery
  • Graft resection, repair of duodenal wall, and new bypass (mortality rate: 30-40%)
  • Gentle resuscitation: SBP goal 60-100
  • Survival rates with treatment: 30-70%

 

References:  MacDougall, L et al. Aorto-enteric fistulas: a cause of gastrointestinal bleeding not to be missed.  BJMP. 2010; 3(2): 317.   Ranasinghe, W et al. Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg. 2011; 25(3): 386; picture

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