Aortoenteric fisulta: Difference between revisions
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**Can be primary or secondary (often due to AAA repair) | **Can be primary or secondary (often due to AAA repair) | ||
**Can form fistula anytime within life of AAA graft repair | **Can form fistula anytime within life of AAA graft repair | ||
***Higher risk with recent graft placement | |||
*Involves the duodenum (ADF) in most cases<ref>Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.</ref> | *Involves the duodenum (ADF) in most cases<ref>Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.</ref> | ||
*Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2% | *Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2% | ||
==Clinical Features== | ==Clinical Features== | ||
*Classic triad | *Classic triad: abdominal pain, GI bleeding and pulsatile abdominal mass | ||
**Present in 23% of patients | |||
*Low grade fever | *Low grade fever | ||
*Abd pain | *Abd pain | ||
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==Workup== | ==Workup== | ||
'''* If suspicion high, involve vascular surgery early''' | '''*If suspicion high, involve vascular surgery early''' | ||
*CBC | *CBC | ||
*Chem 10 | *Chem 10 | ||
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*PT/INR/PTT | *PT/INR/PTT | ||
*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts) | *Blood culture if fever - high risk for infections with secondary fistulas (ie grafts) | ||
* | *[[Ultrasound: Aorta]] and [[Ultrasound: FAST]] to assess for AAA and Free Fluid | ||
*CXR for pre-op, if patient stable | *CXR for pre-op, if patient stable | ||
*EKG for pre-op | *EKG for pre-op | ||
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==Management== | ==Management== | ||
*Fluid resuscitation | |||
*Transfuse pRBCs as needed | |||
*Surgical Intervention | *Surgical Intervention | ||
**Transfer if not available | **Transfer if not available | ||
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==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 00:25, 24 April 2015
Background
- Fistula formed between aorta and intestines
- Can be primary or secondary (often due to AAA repair)
- Can form fistula anytime within life of AAA graft repair
- Higher risk with recent graft placement
- Involves the duodenum (ADF) in most cases[1]
- Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
Clinical Features
- Classic triad: abdominal pain, GI bleeding and pulsatile abdominal mass
- Present in 23% of patients
- Low grade fever
- Abd pain
- Back pain
- H/o AAA graft
- BRBPR
Differential Diagnosis
Undifferentiated lower gastrointestinal bleeding
- Upper GI Bleeding
- Diverticular disease
- Vascular ectasia / angiodysplasia
- Inflammatory bowel disease
- Infectious colitis
- Mesenteric Ischemia / ischemic colitis
- Meckel's diverticulum
- Colorectal cancer / polyps
- Hemorrhoids
- Aortoenteric fistula
- Nearly 100% mortality if untreated
- Consider in patients with gastrointestinal bleeding and known abdominal aortic aneurysms or aortic grafts
- Rectal foreign body
- Rectal ulcer (HIV, Syphilis, STI)
- Anal fissure
Workup
*If suspicion high, involve vascular surgery early
- CBC
- Chem 10
- Type and Cross
- PT/INR/PTT
- Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
- Ultrasound: Aorta and Ultrasound: FAST to assess for AAA and Free Fluid
- CXR for pre-op, if patient stable
- EKG for pre-op
- CTA of abdomen/pelvis, highly sensitive, if patient stable
- Patient may need gastroduodenal endoscopy
Management
- Fluid resuscitation
- Transfuse pRBCs as needed
- Surgical Intervention
- Transfer if not available
Disposition
- Admission
External Links
References
- ↑ Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.