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Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2018 Jun 07; Vol. 18 (1), pp. 113. Date of Electronic Publication: 2018 Jun 07. - Publication Year :
- 2018
-
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.<br />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.<br />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.
- Subjects :
- Aged
Aortic Aneurysm, Abdominal diagnostic imaging
Aortic Aneurysm, Abdominal physiopathology
Aortic Aneurysm, Abdominal surgery
Aortic Diseases diagnostic imaging
Aortic Diseases physiopathology
Aortic Diseases surgery
Aortography methods
Blood Vessel Prosthesis Implantation
Computed Tomography Angiography
Duodenal Diseases diagnostic imaging
Duodenal Diseases physiopathology
Duodenal Diseases surgery
Endovascular Procedures
Gastrointestinal Hemorrhage diagnostic imaging
Gastrointestinal Hemorrhage physiopathology
Gastrointestinal Hemorrhage surgery
Hemodynamics
Hemostatic Techniques
Humans
Intestinal Fistula diagnostic imaging
Intestinal Fistula physiopathology
Intestinal Fistula surgery
Male
Treatment Outcome
Vascular Fistula diagnostic imaging
Vascular Fistula physiopathology
Vascular Fistula surgery
Aortic Aneurysm, Abdominal complications
Aortic Diseases etiology
Duodenal Diseases etiology
Gastrointestinal Hemorrhage etiology
Intestinal Fistula etiology
Vascular Fistula etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 29879911
- Full Text :
- https://doi.org/10.1186/s12872-018-0852-y