Korean J Gastroenterol.  2013 Apr;61(4):230-233. 10.4166/kjg.2013.61.4.230.

A Case of Angiographic Embolization of Aortoenteric Fistula Caused by Endovascular Stent Grafting for an Abdominal Aortic Aneurysm

• Ko KH
• Kim SY
• Jung IS
• Kim KS
• Moon HS
• Seong JK
• Jeong HY

• KMID: 1775764
• DOI: http://doi.org/10.4166/kjg.2013.61.4.230

Abstract

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.

Keyword

Aortoenteric fistula; Abdominal aortic aneurysm; Endovascular stent

MeSH Terms

Aged, 80 and over
Angiography
Aortic Aneurysm, Abdominal/*therapy
Aortic Diseases/*etiology/radiography/therapy
Embolization, Therapeutic
Endoscopy, Gastrointestinal
Fistula/*etiology/radiography/therapy
Gastrointestinal Hemorrhage/therapy
Humans
Male
Stents/*adverse effects
Tomography, X-Ray Computed

Figure

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  Fig. 1. (A) Duodenoscopy showing no evidence of a bleeding focus. (B) Melena was detected by colonoscopy, suggesting bleeding in the upper intestinal tract.

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  Fig. 2. (A) Computed tomography scan showing a bleeding point in the fourth portion of the duodenum, suggesting an aortoenteric fistula (arrow). (B) Computed tomography scan showing a small foci of air around the frame of the device (arrow head).

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  Fig. 3. Angiography showing contrast leakage into the bowel via the fistula tract.

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  Fig. 4. Microcoils were inserted into sac-like dilatation of the fistula tract.

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  Fig. 5. Embolization was performed by injecting a mixture of glue and lipiodol. After the procedure there was no longer any leakage of contrast through the fistula tract.

Reference

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