Difference between revisions of "Aortoenteric fisulta"

(Workup)
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==Background==
 
==Background==
A fistula formed between aorta and intestines, can be primary or secondary (often due to AAA repair)
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*Fistula formed between aorta and intestines
* Can form fistula anytime within life of AAA graft repair
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**Can be primary or secondary (often due to AAA repair)
<big>Incidence</big>: The annual incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
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**Can form fistula anytime within life of AAA graft repair
 +
*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%
  
 
==Clinical Features==
 
==Clinical Features==
* Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients
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*Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients
*Low grade fever,
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*Low grade fever
*abd pain,
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*abd pain
*Back pain,
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*Back pain
*h/o AAA graft
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*H/o AAA graft
 
*BRBPR
 
*BRBPR
  
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==Workup==
 
==Workup==
 
'''* If suspicion high, involve vascular surgery early'''
 
'''* If suspicion high, involve vascular surgery early'''
* CBC
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*CBC
* Chem 10
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*Chem 10
* Type and Cross
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*Type and Cross
* PT/INR/PTT
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*PT/INR/PTT
* chest xray for pre-op, if patient stable
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*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
* EKG for pre-op
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*CXR for pre-op, if patient stable
* CTA of abdomen/pelvis, highly sensitive, if patient stable
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*EKG for pre-op
* Patient may need gastroduodenal endoscopy
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*CTA of abdomen/pelvis, highly sensitive, if patient stable
 +
*Patient may need gastroduodenal endoscopy
  
 
==Management==
 
==Management==
 +
*Surgical Intervention
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**Transfer if not available
  
 
==Disposition==
 
==Disposition==
 
+
*Admission
==See Also==
 
  
 
==External Links==
 
==External Links==

Revision as of 04:37, 5 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
  • 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 of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients
  • Low grade fever
  • abd pain
  • Back pain
  • H/o AAA graft
  • BRBPR

Differential Diagnosis

Lower gastrointestinal bleeding

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)
  • 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

  • Surgical Intervention
    • Transfer if not available

Disposition

  • Admission

External Links

Sources

  1. 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.