Korean Circ J.  2015 Jul;45(4):337-339. 10.4070/kcj.2015.45.4.337.

Primary Aortoenteric Fistula of a Saccular Aneurysm: Case Study and Literature Review

• Varetto G
• Gibello L
• Trevisan A
• Castagno C
• Garneri P
• Rispoli P

• KMID: 1964107
• DOI: http://doi.org/10.4070/kcj.2015.45.4.337

Abstract

Primary aortoenteric fistula is a direct communication between the aorta and intestinal lumen and it represents a rare but potentially lethal complication of an abdominal aortic aneurysm. However, it may occur less frequently in a naive non-aneurysmatic aorta. Diagnosis is often difficult and delayed in most cases, unless there is a high level of clinical awareness. Urgent surgery is still the recommended treatment. We describe the case of primary aortoenteric fistula of a saccular aneurysm. A 55-year-old woman was referred to our center with hematemesis, melena, and severe anemia who was dignosed previously with unknown saccular abdominal aneurysm.

Keyword

Aortic aneurysm, abdominal; Complications; Fistula

MeSH Terms

Anemia
Aneurysm*
Aorta
Aortic Aneurysm, Abdominal
Diagnosis
Female
Fistula*
Hematemesis
Humans
Melena
Middle Aged

Figure

• 

  Fig. 1 Pre-operative CT scan. A: transverse section of the arterial phase CT scan of the abdominal saccular aneurysm with the presence of gas bubbles in the intestinal lumen (white arrows). B: sagittal section of the arterial phase CT scan of the abdominal aorta highlighting the saccular morphology of the aneurysm and the close relationship between the duodenum (*) and the vessel wall. CT: computed tomography.

• 

  Fig. 2 Intraoperative image of the primary aorto-enteric fistula correction with the direct suture of the duodenum (*) and the aortic substitution with a Dacron Silver prosthesis (**).

Reference

1. Lemos DW, Raffetto JD, Moore TC, Menzoian JO. Primary aortoduodenal fistula: a case report and review of the literature. J Vasc Surg. 2003; 37:686–689. PMID: 12618713.

2. Chenu C, Marcheix B, Barcelo C, Rousseau H. Aorto-enteric fistula after endovascular abdominal aortic aneurysm repair: case report and review. Eur J Vasc Endovasc Surg. 2009; 37:401–406. PMID: 19211278.

3. Philippakis GE, Moustardas M. Surgical treatment of primary aortojejunal fistula. Int J Surg Case Rep. 2013; 4:477–479. PMID: 23557938.

4. Genovés-Gascó B, Torres-Blanco Á, Plaza-Martínez Á, Olmos-Sánchez D, Gómez-Palonés F, Ortiz-Monzón E. Primary aortoduodenal fistula in a patient with pararenal abdominal aortic aneurysm. Ann Vasc Surg. 2012; 26:730.e1–730.e5. PMID: 22503432.

5. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005; 92:143–152. PMID: 15685700.

6. Ranasinghe W, Loa J, Allaf N, Lewis K, Sebastian MG. Primary aorto-enteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg. 2011; 25:386.e1–386.e5. PMID: 21269801.

7. Senadhi V, Brown JC, Arora D, Shaffer R, Shetty D, Mackrell P. A mysterious cause of gastrointestinal bleeding disguising itself as diverticu-losis and peptic ulcer disease: a review of diagnostic modalities for aortoenteric fistula. Case Rep Gastroenterol. 2010; 4:510–517. PMID: 21151635.

8. Song Y, Liu Q, Shen H, Jia X, Zhang H, Qiao L. Diagnosis and management of primary aortoenteric fistulas--experience learned from eighteen patients. Surgery. 2008; 143:43–50. PMID: 18154932.

9. Shulik O, Marling K, Butler J. Primary aorto-enteric fistula - a unique complication of poorly differentiated large B-cell lymphoma. Am J Case Rep. 2013; 14:194–197. PMID: 23826466.

10. Kim JS, Han JH, Kang MH, et al. [A case of primary aortoenteric fistula mimicking ulcer bleeding]. Korean J Gastroenterol. 2013; 61:343–346. PMID: 23877216.

11. Lee CW, Chung SW, Song S, Bae MJ, Huh U, Kim JH. Double primary aortoenteric fistulae: a case report of two simultaneous primary aorto-enteric fistulae in one patient. Korean J Thorac Cardiovasc Surg. 2012; 45:330–333. PMID: 23130309.

12. Ramanujam S, Shiels A, Zuckerman G, Prakash C. Unusual presentations of aorto-enteric fistula. Gastrointest Endosc. 2004; 59:300–304. PMID: 14745412.

13. Lawlor DK, DeRose G, Harris KA, Forbes TL. Primary aorto/iliac-enteric fistula-report of 6 new cases. Vasc Endovascular Surg. 2004; 38:281–286. PMID: 15181513.

14. Bala M, Sosna J, Appelbaum L, Israeli E, Rivkind Al. Enigma of primary aortoduodenal fistula. World J Gastroenterol. 2009; 15:3191–3193. PMID: 19575502.

15. Berger P, Moll FL. Aortic graft infections: is there still a role for axillo-bifemoral reconstruction? Semin Vasc Surg. 2011; 24:205–210. PMID: 22230675.

16. Bisdas T, Bredt M, Pichlmaier M, et al. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010; 52:323–330. PMID: 20570473.

17. Chung J, Clagett GP. Neoaortoiliac System (NAIS) procedure for the treatment of the infected aortic graft. Semin Vasc Surg. 2011; 24:220–226. PMID: 22230677.

18. Setacci C, de Donato G, Setacci F. Endografts for the treatment of aortic infection. Semin Vasc Surg. 2011; 24:242–249. PMID: 22230680.

19. Malas MB, Saha S, Qazi U, et al. Is endovascular stent-graft treatment of primary aortoesophageal fistula worthwhile? Vasc Endovascular Surg. 2011; 45:83–89. PMID: 20810403.

20. Danneels MI, Verhagen HJ, Teijink JA, Cuypers P, Nevelsteen A, Vermassen FE. Endovascular repair for aorto-enteric fistula: a bridge too far or a bridge to surgery? Eur J Vasc Endovasc Surg. 2006; 32:27–33. PMID: 16427330.