|
1
|
Du FY, Yu ZQ, Li J, Tan XP. Life-threatening iliac artery-ileum fistula treated with covered stent placement: A case report. Asian J Surg 2023; 46:5062-5063. [PMID: 37422399 DOI: 10.1016/j.asjsur.2023.06.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
- Fu-Yin Du
- Department of Gastroenterology, First Hospital of Yangtze University, Jingzhou of Hubei Province, China; Digestive Disease Research Institution of Yangtze University, Clinical Medical College, Yangtze University, Jingzhou of Hubei Province, China.
| | - Zhi-Qiong Yu
- Clinical Medical College, Yangtze University, Jingzhou of Hubei Province, China; Department of Respiratory Medicine, First Hospital of Yangtze University, Jingzhou of Hubei Province, China.
| | - Jie Li
- Department of Gastroenterology, First Hospital of Yangtze University, Jingzhou of Hubei Province, China; Digestive Disease Research Institution of Yangtze University, Clinical Medical College, Yangtze University, Jingzhou of Hubei Province, China.
| | - Xiao-Ping Tan
- Department of Gastroenterology, First Hospital of Yangtze University, Jingzhou of Hubei Province, China; Digestive Disease Research Institution of Yangtze University, Clinical Medical College, Yangtze University, Jingzhou of Hubei Province, China.
| |
Collapse
|
|
2
|
Li H, Yu Z, Wang J, Zhang Z, Zhang G, Lu Z, Lv J, Tao F, Jin Q. Arteriocolonic fistula of inferior mesenteric artery aneurysm: A case with lower gastrointestinal and intra-abdominal hemorrhage. Heliyon 2023; 9:e13667. [PMID: 36923850 PMCID: PMC10008971 DOI: 10.1016/j.heliyon.2023.e13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Introduction Arteriocolonic fistula of Inferior Mesenteric Artery Aneurysm (IMAA) refers to a spontaneous formation of pathological communication between the artery and the adjacent gastrointestinal tract. It is a rare, life-threatening condition primarily manifesting as abdominal pain, gastrointestinal bleeding, abdominal pulsating masses. However, its clinical manifestations are usually atypical with a difficult diagnosis and treatment. Case presentation We report a rare case of a 50-year-old male with a hemorrhagic shock due to primary arteriocolonic fistula of IMAA. Instead of sigmoidectomy, super selective transcatheter arterial embolization (TAE) was performed after diagnostic angiography. Postoperatively, dynamic contrast-enhanced abdominal computed tomography (CT) demonstrated no recanalization of the aneurysm, absence of abnormal collateral vessels, no active hemorrhage. The patient was discharged uneventfully after 2 weeks without abdominal pain or tension. Discussion Colorectal tumor rupture is a major cause of lower gastrointestinal bleeding (LGIB), with IMAA being an uncommon etiology. Because of the high mortality of explorative laparotomy with an unclear bleeding site, diagnostic angiography and therapeutic TAE are viable options for diagnosing hemodynamic instability. Conclusion Arteriocolonic fistulas commonly occur secondary to a pseudoaneurysm formed at the anastomosis of the transplanted blood vessel after an artery surgery, which ruptures and penetrates into the intestine. We reported a unique case of primary arteriocolonic fistula of IMAA: aneurysm rupture and bleeding from the abdomen into the hematochezia. After multidisciplinary consultations, our patient obtained the best outcome using the most minimally invasive surgical methods. With an abdominal artery aneurysm presenting with colorectal hemorrhage, arteriocolonic fistula of IMAA should be suspected.
Collapse
Affiliation(s)
- Honghai Li
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Zunfang Yu
- Department of Physical Examination Center, Affiliated Hospital of Binzhou Medical University, Binzhou City, Shandong Province, China
| | - JinDao Wang
- Department of Endoscopy Center, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Zhenxing Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Guolin Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Zengxin Lu
- Department of Interventional Radiology, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Jieqing Lv
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Feng Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| | - Qijing Jin
- Department of Ultrasound Medicine, Shaoxing People's Hospital, Shaoxing City, ZheJiang Province, China
| |
Collapse
|
|
3
|
Endovascular Treatment of Abdominal Infection-induced Aortoenteric Fistula. Ann Thorac Surg 2022; 114:e275-e277. [PMID: 34998736 DOI: 10.1016/j.athoracsur.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/21/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022]
Abstract
Primary aortoenteric fistulas is a rare clinical entity but with fatal outcome, usually arise from atherosclerotic aneurysm, but induced by abdominal infection is extremely rare. We present a case of 54-year-old man with history of Aortic arch replacement and elephant trunk stent implantation 6 years ago for Stanford type A aortic dissection. He underwent enteroscopy and had gastrointestinal perforation during enteroscopy 11 months ago. Since then he had episodes of syncope and Haemorrhage. Finally, a fistula was found on imaging. Endovascular treatment and digestive tract repair was accomplished. At 13-month follow-up, he did not have hematochezia and fever again.
Collapse
|
|
4
|
Berner-Hansen V, Olsen AA, Brandstrup B. Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature. World J Gastrointest Endosc 2021; 13:189-197. [PMID: 34163566 PMCID: PMC8209543 DOI: 10.4253/wjge.v13.i6.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
Collapse
Affiliation(s)
- Victoria Berner-Hansen
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
| | - August A Olsen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| |
Collapse
|
|
5
|
Luo J, Tang W, Wang M, Xiao Y, Tan M, Jiang C. Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding. BMC Gastroenterol 2021; 21:49. [PMID: 33530944 PMCID: PMC7856786 DOI: 10.1186/s12876-021-01629-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
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.
Collapse
Affiliation(s)
- Jia Luo
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Wen Tang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Mengran Wang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Yao Xiao
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Manhong Tan
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Chunyan Jiang
- Department of Internal Medicine and Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong' an Road, Xicheng District, Beijing, 100050, People's Republic of China.
| |
Collapse
|
|
6
|
Khalaf C, Houlind KC. Case report: Primary aortosigmoid fistula - A rare cause of lower gastrointestinal bleeding. Int J Surg Case Rep 2017; 40:20-22. [PMID: 28918295 PMCID: PMC5602515 DOI: 10.1016/j.ijscr.2017.08.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/26/2017] [Accepted: 08/27/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A primary aortoenteric fistula (PAEF) is a communication between aorta and the gastrointestinal tract. It is a rare condition that is difficult to diagnose and therefore associated with a high mortality. PRESENTATION OF CASE We report a rare case of a 66-year old man with an unstable bleeding PAEF. A salvage procedure was performed with a covered stent. Later, a sigmoidectomy was performed with resection of the fistula. Postoperatively, the patient suffered an infection that was treated well with antibiotics and he was discharged two weeks later with complete resolution of the fistula. DISCUSSION Aortoenteric fistulas are more common secondary to previous vascular surgery of aorta, however, PAEF's involve the sigmoid in 2%. Seldom, fistulization can be due to diverticulitis that can be difficult to diagnose. CONCLUSION Retroperitoneal bleeding from the left iliac artery is more common due to a ruptured aneurysm. This case, however, demonstrates a special PAEF formation as a very rare complication of diverticulitis. The pathophysiology of the PAEF is very unique along with the anatomic localization in the sigmoid colon and left external iliac artery.
Collapse
Affiliation(s)
| | - Kim C Houlind
- Department of Vascular Surgery, Sygehus Lillebaelt, Denmark
| |
Collapse
|
|
7
|
Karthaus EG, Post ICJH, Akkersdijk GJM. Spontaneous aortoenteric fistula involving the sigmoid: A case report and review of literature. Int J Surg Case Rep 2016; 19:97-9. [PMID: 26741274 PMCID: PMC4756094 DOI: 10.1016/j.ijscr.2015.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/12/2015] [Accepted: 12/12/2015] [Indexed: 12/15/2022] Open
Abstract
PAEF might have an atypical presentation. Colonoscopy, ultrasound and surgical examinations can be misleading. An aggressive diagnostic approach is indicated with the use of a CT-angiography. Surgical treatment is beneficial for the long-term outcome. Introduction Primary aortoenteric fistula (PAEF) is a pathological communication between the aorta and any portion of the gastrointestinal tract. The pathology is very rare and easily overlooked during the diagnostic process. Presentation of Case We report the exceptional case of an 86-year-old man with episodes of abdominal pain and rectal bleeding of unknown cause over a period of 1,5 months due to a PAEF to the sigmoid. A sigmoidectomy was performed and a rifampicin-soaked aortic graft was placed. The patient had an uneventful post-operative recovery. The duration of symptoms, the anatomic location of the fistula and the outcome after surgery makes this case unique. Discussion With an incidence of 0.04–0.07% in all patients with aortic aneurysms a PAEF is very rare. Only 2% of PAEF's involves the sigmoid. The most common cause is an atherosclerotic aortic aneurysm. Patients with PAEF can present with a triad of symptoms including gastrointestinal bleeding, abdominal pain and a pulsating mass. A contrast-enhanced computer-tomography scan (CTa) is the most accurate tool to demonstrate a PAEF. Without a strong clinical suspicion, diagnosing a PAEF is hard and frequently delayed. The overall PAEF-related mortality is high (61–100%) and decreases after surgery (30–40%). Conclusion A primary aortoenteric fistula involving the sigmoid is very rare. Clinical presentation can vary, diagnosis can be difficult and surgical options may differ. Even with low suspicion of PAEF, we recommend performing a CTa. With a high overall mortality of more than 60% due to exsanguinating, surgical treatment is always indicated.
Collapse
Affiliation(s)
| | - Ivo C J H Post
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | |
Collapse
|
|
8
|
Williams AS, Little DL, Herath J. Sudden unexpected death as a result of primary aortoduodenal fistula identified with postmortem computed tomography. Forensic Sci Med Pathol 2015; 11:596-600. [PMID: 26464132 DOI: 10.1007/s12024-015-9719-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
Aortoenteric fistula (AEF) is an uncommon source of upper gastrointestinal (GI) tract hemorrhage, commonly occurring in persons with previous aortic surgery. Non-surgery related AEFs (primary AEFs) may occur in association with atherosclerotic lesions, infections, malignancies, or, rarely, result from penetrating/eroding foreign bodies. Given its rarity, primary AEF is not commonly considered in the pathologist's preliminary list of differential diagnoses at the commencement of an autopsy; however, the use of postmortem cross-sectional imaging may allow for the identification of primary AEF as a reasonable differential diagnoses prior to conventional autopsy. The current case outlines the forensic presentation, postmortem computed tomography (PMCT) features, and autopsy findings of a recent case of primary AEF resulting in lethal gastrointestinal hemorrhage. In such cases, PMCT features supporting primary AEF as the underlying cause of death include an atherosclerotic aneurysm abutting a segment of the GI tract with no definite soft tissue plane of separation, luminal GI contents of similar radiographic density to the aortic contents, lack of previous aortic surgery, and lack of a competing explanation for GI hemorrhage or a competing cause of death. Deaths from massive enteric hemorrhage without a medical history to suggest an underlying cause for the hemorrhage would fall under medicolegal jurisdiction and may, by examination of scene and circumstances alone, initially seem suspicious. This case demonstrates how PMCT could be used by a team of expert forensic radiologists and forensic pathologists to rapidly feedback vital information on the cause and manner of death to the criminal justice system.
Collapse
Affiliation(s)
- Andrew S Williams
- Division of Anatomical Pathology - QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - D'Arcy L Little
- Ontario Forensic Pathology Service, Ministry of Community Safety and Correctional Services, 25 Morton Shulman Avenue, Toronto, ON, M3M OB1, Canada
| | - Jayantha Herath
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. .,Ontario Forensic Pathology Service, Ministry of Community Safety and Correctional Services, 25 Morton Shulman Avenue, Toronto, ON, M3M OB1, Canada.
| |
Collapse
|