Two Cases of Primary Aortoenteric Fistulas Diagnosed by Computed Tomography

Document Type

Article

Publication Date

6-1-2024

Publication Title

Cureus

Abstract

A primary aortoenteric fistula is a rare clinical entity that leads to severe upper gastrointestinal bleeding and carries a high risk of mortality, yet diagnosing aortoenteric fistulas remains challenging. Diagnosis is frequently delayed due to the uncommon and non-specific nature of the abdominal signs and symptoms. Rapid diagnosis and prompt surgical intervention are paramount to the successful management of this condition which is known for its profoundly poor prognosis. This report describes two cases of primary aortoenteric fistulas, one of which presented with melena and hematemesis, and the other presented with hematemesis and abdominal pain. In both cases, computed tomography angiography (CTA) demonstrated findings suggestive of an aortoenteric fistula, namely, locules of gas within the aortic lumen, which led to emergent surgical intervention. One patient underwent esophagogastroduodenoscopy while in the operating room before surgical intervention. One patient underwent repair with axillo-bifemoral bypass and the other with juxtarenal abdominal aortic aneurysm repair with a rifampin-soaked gelsoft dacron graft followed by primary bowel repair. Postoperative complications for one of the patients included duodenal repair breakdown as well as colonic ischemia. One patient made a meaningful recovery and remained without complications until the first postoperative visit two months after the repair. The other patient was discharged and then subsequently lost to follow-up. The two patients' successful outcomes of such a lethal condition were in large part due to rapid diagnosis with CTA and prompt surgical intervention.

PubMed ID

39070467

Volume

16

Issue

6

First Page

63406

Last Page

63406

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