Difference between revisions of "Aortoenteric fisulta"

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*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%
 +
*Mortality of 100% if left untreated
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 18:12, 10 August 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%
  • 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
  • Abd pain
  • Back pain
  • H/o AAA graft
  • BRBPR or melena
  • Herald bleed - initial melena or hematochezia w/ few hemodynamic changes; then followed by severe bleed

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)
  • 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

  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.