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Observational Study
. 2021 Feb 1;21(1):45.
doi: 10.1186/s12876-021-01616-9.

Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study

Chikamasa Ichita  1 , Akiko Sasaki  2 , Chihiro Sumida  2 , Karen Kimura  2 , Takashi Nishino  2 , Junichi Tasaki  2 , Sakue Masuda  2 , Kazuya Koizumi  2 , Jun Kawachi  3 , Makoto Kako  2
Affiliations
Observational Study

Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study

Chikamasa Ichita et al. BMC Gastroenterol. .

Abstract

Background: Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease.

Methods: The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital.

Results: The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients' mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful.

Conclusions: In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.

Keywords: Aorto-duodenal fistula; Aorto-enteric fistula; Upper gastrointestinal bleeding.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart showing diagnosis of aorto-duodenal fistula. ADF Aortoduodenal fistula, CT computed tomography
Fig. 2
Fig. 2
Contrast computed tomography image after upper endoscopy (case 2). Arrowhead: Image of air in the aorta
Fig. 3
Fig. 3
Upper endoscopy (case 1). A pulsatile, granulation-like protuberance in the 3rd portion of the duodenum
Fig. 4
Fig. 4
Upper endoscopy (case 8). Massive fresh bleeding of obscure origin is observed up to the 3rd portion of the duodenum
Fig. 5
Fig. 5
Upper endoscopy (case 2). Exposure of an aortic stent in the 2nd portion of the duodenum
Fig. 6
Fig. 6
Upper endoscopy (case 6). Pulsatile erosion in the 3rd portion of the duodenum. A marking clip is placed on the opposite side
Fig. 7
Fig. 7
Upper endoscopy (case 5). Pulsatile blood clot in the 3rd portion of the duodenum. A marking clip is placed on the opposite side
Fig. 8
Fig. 8
Upper endoscopy (case 4). Massive fresh bleeding of obscure origin is observed up to the 3rd portion of the duodenum
Fig. 9
Fig. 9
Contrast computed tomography image after an upper endoscopy (case 5). Arrow (solid red)/arrowhead (red): extravascular leakage from the aorta to the duodenum is observed. Arrow (dotted orange): image of air seen in the aorta
Fig. 10
Fig. 10
Simple computed tomography (CT) image after an upper endoscopy (case 6). Arrowhead: a cyst-shaped aneurysm adjacent to the duodenum is seen. Arrowhead: since a marking clip was placed on the opposite side, diagnosis of aorto-duodenal fistula was easy, even with a simple CT
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References

    1. Hirst AE, Jr, Affeldt JE. Abdominal aortic aneurysm with rupture into the duodenum. A report of eight cases. Gastroenterology. 1951;17:504–514. doi: 10.1016/S0016-5085(51)80061-1. - DOI - PubMed
    1. Okada A, Yoshimura T, Tatsuta T, Sakuraba H, Hanabata N, Shimoyama T, et al. A case of graft-duodenal fistula 25 years after operation for aortic coarctation. J Jpn Soc Gastroenerol. 2012;109:2049–2057. - PubMed
    1. Matsuura N, Fujitani K, Nakatsuka R, Miyazaki S. Secondary aortoduodenal fistula: report of 3 cases. Jpn J Gastroenterol Surg. 2018;51:406–414. doi: 10.5833/jjgs.2017.0005. - DOI
    1. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005;92:143–152. doi: 10.1002/bjs.4928. - DOI - PubMed
    1. Delgado J, Jotkowitz AB, Delgado B, Makarov V, Mizrahi S, Szendro G. Primary aortoduodenal fistula: pitfalls and success in the endoscopic diagnosis. Eur J Intern Med. 2005;16:363–365. doi: 10.1016/j.ejim.2005.01.018. - DOI - PubMed

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