View source for Aortoenteric fisulta

==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<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%
*Mortality of 100% if left untreated

==Clinical Features==
*Classic triad: [[abdominal pain]], [[GI bleeding]] and pulsatile abdominal mass 
**Present in 23% of patients
*Low grade [[fever]]
*[[Abdominal pain]]
*[[Back pain]]
*History of [[AAA]] graft
*[[BRBPR]] or [[melena]]
**Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed

==Differential Diagnosis==
{{UGIB DDX}}
{{Lower GI bleeding DDX}}

==Evaluation==
[[File:AortoEntericFistulaDissectionMark.png|thumb|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]
[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png|thumb|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]
'''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)
*[[Aortic ultrasound]] and [[FAST exam]] to assess for AAA and Free Fluid
*[[CXR]] for pre-op, if patient stable
*[[ECG]] 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==
<references/>

[[Category:GI]]
[[Category:Vascular]]
[[category:Surgery]]