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[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

Differential Diagnosis

Upper gastrointestinal bleeding

Mimics of GI Bleeding

Lower gastrointestinal bleeding

Evaluation

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

  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.