Korean J Gastroenterol.  2014 Apr;63(4):239-243. 10.4166/kjg.2014.63.4.239.

Primary Aortoenteric Fistula to the Sigmoid Colon in Association with Intra-abdominal Abscess

• Lee W
• Jung CM
• Cho EH
• Ryu DR
• Choi D
• Kim J

• KMID: 1791881
• DOI: http://doi.org/10.4166/kjg.2014.63.4.239

Abstract

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of massive gastrointestinal bleeding. Diagnosis of PAEF is difficult to make and is frequently delayed without strong clinical suspicion. Timely surgical intervention is essential for patient's survival. We report on a case of an 86-year-old woman with no history of abdominal surgery, who presented with abdominal pain. Initially, computed tomography scan showed an intra-abdominal abscess, located anterior to the aortic bifurcation. However, she was discharged without treatment because of spontaneous improvement on a follow-up computed tomography scan, which showed a newly developed right common iliac artery aneurysm. One week later, she was readmitted due to recurrent abdominal pain. On the second day of admission, sudden onset of gastrointestinal bleeding occurred for the first time. After several endoscopic examinations, an aortoenteric fistula bleeding site was found in the sigmoid colon, and aortography showed progression of a right common iliac artery aneurysm. We finally concluded that intra-abdominal abscess induced an infected aortic aneurysm and enteric fistula to the sigmoid colon. This case demonstrated an extremely rare type of PAEF to the sigmoid colon caused by an infected abdominal aortic aneurysm, which has rarely been reported.

Keyword

Primary aortoenteric fistula; Abdominal aortic aneurysm; Abdominal abscess; Sigmoid colon; Gastrointestinal hemorrhage

MeSH Terms

Abdominal Abscess/*diagnosis/microbiology
Aged, 80 and over
Aorta, Abdominal/radiography
Aortic Aneurysm, Abdominal/*diagnosis/etiology
Bacteroides/isolation & purification
Bacteroides fragilis/isolation & purification
Colon, Sigmoid/radiography
Colonoscopy
Enterococcus/isolation & purification
Female
Fistula/*diagnosis
Humans
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. Contrast-enhanced CT scans. (A) Low density lesion measuring approximately 5.2 cm in size (arrow) with peripheral enhancement was observed anterior to the aortic bifurcation without aortic aneurysm on an initial CT scan. (B) Low density lesion invaded the common-iliac artery (black arrow) and distal sigmoid colon (white arrow) on an initial CT scan. (C, D) Ten days later, follow-up CT scan showed a newly developed right common iliac artery aneurysm with air (arrows).

• 

  Fig. 2. (A) Initial colonoscopy showed a nodular lesion with central dimpling at the sigmoid colon and biopsy was performed here. (B) Follow-up colonoscopy showed bloody oozing at the previous lesion after biopsy. (C, D) Electrocauterization and clipping were performed at the bleeding site. After the endoscopic treatments, there was no further bleeding.

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  Fig. 3. After massive bleeding, emergency aortography was performed. It showed a known aneurysm measuring approximately 2 cm size (arrowhead) and a newly developed aortic aneurysm measuring approximately 5 cm in size (arrow) at the right common iliac artery.

Reference

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