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. 2021 Feb 2;21(1):49.
doi: 10.1186/s12876-021-01629-4.

Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding

Jia Luo  1 , Wen Tang  1 , Mengran Wang  1 , Yao Xiao  1 , Manhong Tan  1 , Chunyan Jiang  2
Affiliations

Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding

Jia Luo et al. BMC Gastroenterol. .

Abstract

Background: Aortoenteric fistula (AEF) is a rare cause of gastrointestinal bleeding and is often misdiagnosed in clinical practice. Herein, a case series of AEFs are presented and the clinical characteristics, diagnosis, and management strategies are summarized.

Methods: A retrospective analysis was performed on consecutive hospitalized patients with a final diagnosis of AEF at Beijing Friendship Hospital, Capital Medical University, between January 1, 2007 and March 31, 2020. The clinical data including diagnostic and management procedures as well as outcomes were collected and summarized.

Results: A total of nine patients were included in this study, five with primary AEF and four with secondary AEF. Eight of the patients were male, and the median age was 63 years. The fistulas were located in both the small intestine and the colon. All patients presented with gastrointestinal bleeding and pain, followed by weight loss, anorexia, and fever. A typical abdominal triad was found in only two cases. Seven patients experienced complications with preoperative abdominal infections and sepsis, and multiple organ failure occurred in four of these patients. All patients were assessed by computed tomography and five underwent abdominal and/or iliac aorta angiography. Two of these patients showed contrast agent leakage from the abdominal aorta into the intestine. Two cases were diagnosed with AEF by endoscopy before the operation. Eight patients received surgery and six patients survived.

Conclusions: AEF is a rare cause of gastrointestinal bleeding that is associated with high mortality. Gastrointestinal bleeding and pain are the most common presentations. Timely diagnosis and multidisciplinary management are crucial to achieve a positive outcome.

Keywords: Aortoenteric fistula; Clinical characteristics; Gastrointestinal bleeding; Management.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Fig. 1
Fig. 1
Computed tomography (CT) showed equi- or low-density soft tissue collection around the aorta and an unclear boundary between the aorta and bowel
Fig. 2
Fig. 2
Computed tomography (CT) showed ectopic gas within or adjacent to the right external iliac artery, and equi- or low-density soft tissue collection around the right external iliac artery as well as encapsulated fluid around the right psoas major and iliacus muscles
Fig. 3
Fig. 3
Duodenoscopy showed a mucosa uplift at the beginning of the horizontal section of the duodenum indicating external pressure from the aneurysm, with an apical thrombus suggesting the presence of recent bleeding
Fig. 4
Fig. 4
Duodenal endoscopy showed a fistula in the horizontal segment of the duodenum, where the aortic graft had penetrated the bowel wall
See this image and copyright information in PMC

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