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Aorto-duodenal fistula (ADF) is a rare cause of upper gastrointestinal bleeding, but it is associated with high mortality. It usually occurs in patients with prior aortic surgery or who have undergone aortic graft placement. Abdominal aortic aneurysm (AAA) might be a cause of primary ADF, which could develop into sudden shock. Because ADF is difficult to diagnose, surgery to correct it has a poor outcome. We here report the successful treatment of an ADF complicated with infected AAA after endovascular repair of a ruptured aneurysm of the iliac artery.

A case report focused on imaging aspects of an aorto-enteric fistula (AEF) in a 39-year-old patient with a recent diagnosis of classic Hodgkin Lymphoma with multiple enlarged retroperitoneal lymph nodes. AEF is a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract. Without prompt intervention, the associated mortality approaches 100%. Early clinical suspicion is essential for a successful outcome and the role of imaging is fundamental to diagnose it. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aorto-enteric fistula. [ABSTRACT FROM AUTHOR]

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.

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

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. [ABSTRACT FROM AUTHOR]

Introduction Communications between an artery and the bowel are termed arterio-enteric fistulae. These are uncommon and mainly involve the aorta and duodenum. They can cause fatal haemorrhage. A primary aorto-enteric fistula has several aetiologies, one of which is post-radiotherapy. Case report 75-year old gentleman presented with acute upper gastrointestinal bleeding and haemorrhagic shock. He had a past history of right colonic cancer treated by resection and radiotherapy. At emergency gastroscopy he became critically unstable and the procedure was unsuccessful to achieve haemostasis. After resuscitation, a CT angiogram confirmed a right ilio-duodenal fistula between the right common iliac artery and duodenum. Interventional radiology was performed and a covered stent was inserted in the right common iliac artery. The patient recovered and was subsequently discharged from hospital. Three months later, he presented once again with similar massive haematemesis. Despite all efforts to stabilise him, he passed away a few hours after this second admission. Discussion This case highlights what could possibly be a limitation of interventional radiology in providing definitive treatment for such a presentation. There are no set guidelines for the management of bleeding aorto-duodenal fistulae and literature is scarce. This makes it difficult to treat and the outcome is relatively unpredictable. Conclusion While minimally invasive radiological techniques are invaluable in many areas and life-saving in countless emergency bleeds, cases like these should ideally not be treated by stenting alone. It would be wise to follow arterio-enteric fisula bleeds by definitive open surgical repair. [ABSTRACT FROM AUTHOR]

Introduction. Aortoenteric fistulas constitute a rare, but severe clinical problem involving a pathological connection between the abdominal aorta and gastrointestinal tract. We distinguish primary and, much more frequent, secondary fistulas. All such fistulas require urgent surgical treatment. Currently, the most common treatment method involves open in situ prosthesis replacement or an extra-anatomical by-pass. Endovascular procedures offer an alternative to open surgery, but remain controversial. Material and methods. The analysis included 6 surgical procedures in 5 patients with aorto-duodenal fistula treated at the Department of Surgery of the 4. Military Clinical Hospital over the years 2010-2016. Open surgery was performed in 4 cases, while 2 patients underwent stentgraft implantation. Diagnostics consisted of an angio-CT and upper gastrointestinal tract endoscopy. All patients were diagnosed with radiological signs of prosthesis infection, 2 of 6 patients died during the perioperative period. Surgical complications were observed in 5 of 6 cases (83%). Results. Endovascular treatment was associated with a reduction in the number of early postoperative complications and shortening of hospital stay. Conclusions. Based on the results and literature data, stentgraft implantation into the aorto-duodenal fistula appears to be a viable alternative treatment method. [ABSTRACT FROM AUTHOR]

The last few years have seen an increase in popularity of endovascular aneurysm repair because of the improvements made to the endografts design as well as experience gained by physicians, but the long-term results of this procedure are still uncertain. The majority of late complications after an endograft can be treated with an endovascular approach but, in some cases, it may need conversion to open surgery. In this paper, we discuss the case of a male patient who presented with an aorto-duodenal fistula on an endograft requiring explant. After two operations and 20 days in hospital, the patient was discharged and after 1 year he is doing well. In medical literature, there are very few reported cases of aortoenteric fistula complicating endovascular prosthesis, the diagnosis is quite difficult, surgical treatment is fairly complex consisting in endograft removal and we refer to our experience on this difficult and life-threatening operation. [ABSTRACT FROM AUTHOR]

Introduction Primary aorto-enteric fistula (PAEF) is a life threatening, spontaneous erosion and communication of the aorta and intestinal tract. Unlike secondary AEF, which occur following aortic surgery, they are extremely rare. The low clinical suspicion and difficulty in obtaining a definitive diagnosis make for a dismal prognosis. Case presentation A literature review highlighted aetiology which included gallstone erosion, carcinoma of the pancreas and duodenal diverticulum. With written consent, we present the case of a 59 year old female, brought to the hospital following an episode of haematemesis and later found to have an AEF, secondary to metastatic retroperitoneal carcinoma - an extremely rare aetiology. Discussion There is far less literature on primary AEF when compared to secondary AEF. Furthermore, there is a variation in aetiology. Identifying the presence of a ‘herald' bleed appears to be significant. Conclusion Aorto-enteric fistulae must always be considered as a potential diagnosis in the setting of an acute upper GI haemorrhage with no apparent cause. [ABSTRACT FROM AUTHOR]

Aortic graft-enteric fistula is life-threatening complication of aortic reconstruction surgery. It is a rare condition but its frequency is rising because of an increase of patients who underwent to aortic aneurysm repairs with prosthetic implants. We report a case of a 72 years-old man with secondary aorto-duodenal fistula. The man presented haematochezia and mild normocytic anaemia; the patient had undergone an aorticbifemoral bypass 8 years earlier because of subrenal abdominal aortic aneurysm. An urgent upper endoscopy showed the aortic graft crossing the third segment of the eroded duodenal wall with no signs of bleeding from the prosthesis. He underwent an emergent operation to repair the graft-enteric fistula, to have the partial removal of the graft, as well as an aneurysmectomy and implantation of new endoaortic graft. The post-operative course was uneventful and the patient was discharged two weeks after the operation. He received a regular follow up. A secondary aorto-duodenal fistula is rarely diagnosed in an early phase as a herald haemorrhage. A precocious identification of this condition is thus essential to refer the patient to an urgent operation and to reduce the associated mortality. [ABSTRACT FROM AUTHOR]

An aorto-enteric fistula is a serious complication of abdominal aortic aneurysm. Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action. Morbidity and mortality remain high despite progress in diagnosis and therapeutic procedures. In the literature, the aorto-enteric fistula diagnostic suspicion by multidetector computed tomography scan is assumed on the basis of the interruption of the aortic wall, with the presence of duodenal gas situated to tightened contact with the aorta. We report a patient with an aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm detected by gastro-duodenoscopy and multidetector computed tomography scan, with gas found in the lumen of the abdominal aorta, between the aneurysm wall and the thrombus. [ABSTRACT FROM AUTHOR]

The incidence of primary aorto-enteric fistula (PAEF) is low with only few case reports and case series published. Depending on the location of the PAEF, the perforation leads to upper or lower gastrointestinal haemorrhages. We conducted a MEDLINE search according to the PRISMA statement. Articles with publication dates from 2000 to 2016 were included and present an own case report. We considered all case reports and series reporting on PAEF and identified 85 individual patients from 32 case reports and five case series. The majority of PAEF is associated with atherosclerotic or aneurysmatic findings of the aorta and in particular with inflammatory aortic diseases. Most commonly, the duodenum (64 %) was mentioned as location of the perforation. Other cases involved the jejunum (< 10 %) and the colon (5 %). Almost all patients were diagnosed either with gastrointestinal haemorrhage, abdominal or back pain, or anaemia due to bleeding. The immediate and correct diagnosis of this entity remains difficult. Therefore, treatment is delayed leading to an extraordinary high mortality of almost 100 % in untreated cases. Duplex ultrasound and contrast-enhanced CT angiography have high diagnostic sensitivity and specificity to rule out acute abdominal aortic pathologies. New endovascular approaches can help to lower mortality.