Difference between revisions of "Aortoenteric fisulta"
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==Background== | ==Background== | ||
| − | + | *Fistula formed between aorta and intestines | |
| − | * Can form fistula anytime within life of AAA graft repair | + | **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<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 | + | *Classic triad of abdominal pain, GI bleeding and pulsatile abdominal mass only present in 23% of patients |
| − | *Low grade fever | + | *Low grade fever |
| − | *abd pain | + | *abd pain |
| − | *Back pain | + | *Back pain |
| − | * | + | *H/o AAA graft |
*BRBPR | *BRBPR | ||
| Line 17: | Line 19: | ||
==Workup== | ==Workup== | ||
'''* If suspicion high, involve vascular surgery early''' | '''* If suspicion high, involve vascular surgery early''' | ||
| − | * CBC | + | *CBC |
| − | * Chem 10 | + | *Chem 10 |
| − | * Type and Cross | + | *Type and Cross |
| − | * PT/INR/PTT | + | *PT/INR/PTT |
| − | * | + | *Blood culture if fever - high risk for infections with secondary fistulas (ie grafts) |
| − | * EKG for pre-op | + | *CXR for pre-op, if patient stable |
| − | * CTA of abdomen/pelvis, highly sensitive, if patient stable | + | *EKG for pre-op |
| − | * Patient may need gastroduodenal endoscopy | + | *CTA of abdomen/pelvis, highly sensitive, if patient stable |
| + | *Patient may need gastroduodenal endoscopy | ||
==Management== | ==Management== | ||
| + | *Surgical Intervention | ||
| + | **Transfer if not available | ||
==Disposition== | ==Disposition== | ||
| − | + | *Admission | |
| − | |||
==External Links== | ==External Links== | ||
Revision as of 04:37, 5 April 2015
Contents
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
- 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)
- 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
- ↑ 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.