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Case Reports
. 2018 Jun 7;18(1):113.
doi: 10.1186/s12872-018-0852-y.

Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

Tzu-Chieh Lin  1   2   3 , Chung-Lin Tsai  4 , Yao-Tien Chang  1   3 , Sung-Yuan Hu  5   6   7   8   9
Affiliations
Case Reports

Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

Tzu-Chieh Lin et al. BMC Cardiovasc Disord. .

Abstract

Background: Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate.

Case presentation: We report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5 days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta.

Conclusions: A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.

Keywords: Abdominal aortic aneurysm (AAA); Aortoduodenal fistula (ADF); Computed tomographic angiography (CTA); Endovascular aortic repair (EVAR); Gastrointestinal (GI) bleeding.

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Conflict of interest statement

Ethics approval and consent to participate

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Taichung Veterans General Hospital (Number CE13233).

Consent for publication

Written informed consent was obtained from the patient to the use of his history and all the related images and information for scientific purposes.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Computed tomographic angiography (CTA) of aorta depicted swollen and dilated bowel loop, contrast within bowel loop (white arrow), air bubble (black arrow), and an abdominal aortic aneurysm (AAA) (white arrow in reconstructed image of CTA)
Fig. 2
Fig. 2
Angiography of aorta demonstrated an infrarenal AAA (white arrow in pre-stent) and a modified aorto-uni-iliac stent graft with resolution of an infrarenal AAA after implantation (post-stent)
Fig. 3
Fig. 3
Exploratory laparotomy showed a fistula about 2x2cm over the third portion of duodenum
See this image and copyright information in PMC

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