• aortic aneurysm
• aortic endoprosthesis
• aortoenteric fistula
• ct imaging
• gastrointestinal hemorrhage

• Aorto-esophageal fistula
• Button battery
• Endoscopy
• Foreign body ingestion
• Pediatric
• Vascular injury

• Humans
• Foreign Bodies/complications
• Electric Power Supplies/adverse effects
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Algorithms
• Vascular System Injuries/etiology
• Vascular System Injuries/therapy
• Vascular System Injuries/diagnosis
• Endoscopy, Gastrointestinal

• Fistula
• duodenum
• jejunostomy
• treatment

• Humans
• Male
• Aged
• Female
• Intestinal Fistula/surgery
• Aortic Aneurysm, Abdominal/surgery
• Middle Aged
• Duodenal Diseases/surgery
• Treatment Outcome
• Duodenum/surgery
• Aged, 80 and over
• Length of Stay
• Retrospective Studies
• Republic of Korea

• aortoenteric fistula
• common iliac artery
• fistula
• gastrointestinal bleeding
• sigmoid colon

• Humans
• Male
• Aged
• Diagnostic Errors
• Intestinal Fistula/surgery
• Intestinal Fistula/diagnostic imaging
• Intestinal Fistula/etiology
• Iliac Aneurysm/surgery
• Iliac Aneurysm/diagnostic imaging
• Vascular Fistula/diagnostic imaging
• Vascular Fistula/surgery
• Vascular Fistula/etiology
• Treatment Outcome
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Predictive Value of Tests
• Gastrointestinal Stromal Tumors/surgery
• Gastrointestinal Stromal Tumors/diagnostic imaging
• Gastrointestinal Stromal Tumors/complications
• Time-to-Treatment
• Time Factors
• Delayed Diagnosis
• Computed Tomography Angiography
• Colectomy
• Colonic Diseases/surgery
• Colonic Diseases/etiology
• Colonic Diseases/diagnostic imaging
• Treatment Delay

• abdominal aortic aneurysm
• aorta
• aortoenteric fistula
• secondary

• Insitu aortic repair
• abdominal aortic aneurysm
• aortoduodenal fistula
• brucella aortitis
• brucellosis

• aortic graft infection
• aorto-enteric fistula
• endovascular
• evar
• secondary aorto-enteric fistula

• Humans
• Female
• Middle Aged
• Aged
• Aged, 80 and over
• Male
• Endovascular Procedures
• Cohort Studies
• Treatment Outcome
• Aortic Aneurysm, Abdominal/surgery
• Survival Analysis
• Retrospective Studies
• Risk Factors
• Blood Vessel Prosthesis Implantation
• Postoperative Complications/etiology

Background: Secondary aortoenteric fistula is an iatrogenic complication after aortic reconstructive surgery presenting with gastrointestinal bleeding and/or infectious symptoms. Infrequently, it may manifest with nonspecific and atypical clinical signs. We present a case of necrotizing fasciitis of the thigh complicating secondary aortoduodenal fistula, diagnosed with CT-scan. Case presentation: A 67-year-old man with a history of an open aortic-bifemoral bypass 6 years ago was admitted for a progressively swollen and painful right thigh for the last month. Through laboratory and morphological (CT-scan) investigations, a secondary aortoduodenal fistula associated with necrotizing fasciitis of the right thigh was discovered. After general supportive care and empiric antibiotherapy, the patient underwent a prosthetic explantation, a resection of the perforated bowel with end-to-end anastomosis, and extensive debridement of the necrotic tissue of the thigh. No revascularization has been attempted. The patient died the next day of multiple organ failure. Conclusion: Secondary aortoenteric fistula is rare but with a poor prognosis. Clinical presentation is not always typical. A high index of suspicion is the most important factor for improving outcomes. There is not a consensus about optimal management. Axillo-bifemoral revascularization and subsequent graft removal seem to be the best therapeutic option.

An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000–11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass.

Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.

• aorto-enetric fistula
• duodenal stent
• duodenal ulceration
• gastro intestinal bleeding
• hematochezia
• massive blood transfusion
• massive hemoptysis
• metastatic rcc

Aorto-esophageal fistula (AEF) is a rare serious surgical event. The first case developed hematemesis 2 weeks post-sleeve gastrectomy. A covered esophageal stent was placed endoscopically. The esophageal stent implantation was followed by massive bleeding due to an AEF. A thoracic endovascular aortic repair (TEVAR) was performed. Aggravated by infection of the aortic stent, another massive bleed occurred after 1 year. The final procedure was resection of the descending aorta with reconstruction using a bovine pericardial patch. The second case presented with hematemesis post-motor vehicle accident. AEF was confirmed by aortogram and treated by TEVAR followed by fully covered esophageal stent. The patient declined definite surgery. In conclusion, initial endovascular approach is useful as a bridge procedure. Once the patient hemodynamics are stabilized, a definitive surgical repair is required. The post-repair infection and life-long antibiotics could be overcome by using bovine pericardial grafts.

• aorto-esophageal
• aortoenteric
• endovascular repair
• fistula
• gastrectomy
• surgery
• trauma

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.

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.

Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.

• Endoscopy
• Gastrointestinal haemorrhage
• Surgical clip
• Intestinal fistula, Vascular fistula
• Systematic review
• Case report

• Aortic Graft
• Aortoenteric Fistulization
• Bowel Obstruction

The presentation of a massive upper gastrointestinal bleed (UGIB) due to an aortoenteric fistula (AEF) is a rare occurrence. A high index of suspicion is required to rapidly make the diagnosis and execute prompt surgical management. Despite the many surgical options described, the survival rate continues to be low. Conventional surgical management is associated with a high morbidity and mortality. However, in emergencies, patients are unsuitable for major vascular surgery and may benefit from the less invasive staged procedure. This is a case report of a secondary aortoenteric fistula (SAEF) presenting as a massive UGIB, two years after an abdominal aortic aneurysm repair using a Dacron graft. Due to a lack of endovascular service in our setting, we proceeded with an upper gastrointestinal endoscopy followed by exploratory laparotomy. A damage control approach was chosen for our patient, i.e., local repair of the graft and aorta, as our patient was on double inotropes on the table. The patient died within 24 hours as a result of massive blood volume loss.

• aorto-enetric fistula
• endovascular technique
• extra-anatomic bypass
• local repair
• outcomes

Aortoenteric fistulas are an uncommon cause of gastrointestinal bleeding, and iliac-appendiceal fistulas are an even rarer cause. We describe a case of an iliac-appendiceal fistula in a patient who presented several months after aortic reconstruction with gastrointestinal bleeding. An extensive workup revealed that the source of bleeding was localized to the appendiceal orifice. The patient underwent an appendectomy with a two-stage procedure involving the iliac graft for definitive repair and ultimately recovered well. Despite the rarity of aortoenteric and iliac-appendiceal fistulas causing gastrointestinal bleeding, keeping a high index of suspicion in patients with a prior vascular repair can prevent death.

• Aortoenteric fistula
• Gastrointestinal bleeding
• Iliac-appendiceal fistula

• Duodenal resection
• endovascular repair
• endovascular stent graft
• high-risk patients
• secondary aortoenteric fistula

• Duodenum
• Humans
• Intestinal Fistula

• aortoesophageal fistula (AEF)
• endoleak
• perigraft abscess

• Abscess/diagnosis
• Abscess/etiology
• Aged
• Aortic Aneurysm, Thoracic/surgery
• Blood Vessel Prosthesis/adverse effects
• Endoscopy, Gastrointestinal
• Esophageal Fistula/complications
• Esophageal Fistula/diagnosis
• Fatal Outcome
• Humans
• Male
• Tomography, X-Ray Computed
• Vascular Fistula/complications
• Vascular Fistula/diagnosis

•

Primary aortoduodenal fistula (PADF) is extremely rare.

Primary aortoduodenal fistula (PADF) is an abnormal connection between the aorta and the duodenum and is a life-threatening condition. It is a very rare cause of gastrointestinal bleeding, which often leads to delay in its diagnosis. Prompt diagnosis and surgical treatment are crucial to improve the outcome of patients with PADF.

An 82-year-old man with a history of untreated abdominal aortic aneurysm (AAA) presented to the emergency department with hematemesis. Computed tomography (CT) revealed an AAA with air within the thrombus wall and disruption of the fat layer between the AAA and duodenum, indicating PADF. Emergent surgery, in situ aortic reconstruction using a Dacron graft, and omental coverage were performed. Although the patient needed another surgery for postoperative chylous ascites, he made good recovery and was discharged 86 days after initial surgery.

In our case, the patient presented with hematemesis and a pulsatile abdominal mass on physical examination and had a history of untreated AAA, which helped in prompt diagnosis of PADF. CT findings suggesting PADF include disappearance of the fat plane between the aneurysm and duodenum, air in the retroperitoneum or within the aortic wall, and contrast enhancement within the duodenum. The recommended surgical approach for PADF consists of aortic reconstruction (in situ aortic reconstruction or extra-anatomical bypass) and duodenal repair.

Our report affirms that CT and open surgery are effective diagnostic and treatment options, respectively, for PADFs.

• Abdominal aortic aneurysm
• Aortoduodenal fistula
• Primary aortoduodenal fistula

• elderly
• gastrointestinal bleeding
• retroperitoneal abscess
• secondary aortoenteric fistula (saef)
• treatment

• Abdominal Abscess/etiology
• Abdominal Abscess/surgery
• Aged, 80 and over
• Aorta, Abdominal/pathology
• Aorta, Abdominal/surgery
• Aortic Aneurysm, Abdominal/complications
• Aortic Aneurysm, Abdominal/surgery
• Blood Vessel Prosthesis Implantation/adverse effects
• Duodenum/pathology
• Duodenum/surgery
• Endoscopy, Gastrointestinal
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Humans
• Intestinal Fistula/complications
• Intestinal Fistula/surgery
• Laparotomy/methods
• Male
• Retroperitoneal Space/pathology
• Stents/adverse effects
• Tomography, X-Ray Computed
• Treatment Outcome

• Imaging
• aorto-enteric fistula (AEF)
• endovascular treatment
• surgical options

An aorto-gastric fistula is a catastrophic and rare cause of an upper gastrointestinal bleed. The diagnosis requires a high index of suspicion and expedient management as any delay in each of these component, will be to the detriment of the patient. We report a case of a patient with two episodes of this rare event, with haemodynamic compromise, 15 years after having had a trans-hiatal oesophagectomy for an adenocarcinoma of the oesophagus who presented on both occasions. He had thoracic endo-vascular aortic repair (TEVAR) on both presentations and survived. This case exemplifies the fact that while TEVAR is a good bridging therapy for the management of an aorto-enteric fistula. It however should not be considered as the definitive management for patients who are operable or patients who do not have prohibitive surgical risk.

• Aorto-digestive fistula
• Cryopreserved arterial allograft
• Prosthetic infection
• Vascular infection

Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

• abdominal aortic aneurysm
• aortoduodenal fistula
• aortoenteric fistula
• gastrointestinal bleeding

• Adult
• Cholangiopancreatography, Magnetic Resonance/methods
• Contrast Media
• Duodenal Diseases/diagnosis
• Duodenum/diagnostic imaging
• Duodenum/pathology
• Female
• Fluoroscopy/methods
• Humans
• Image Enhancement/methods
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Multimodal Imaging/methods
• Tomography, X-Ray Computed/methods
• Young Adult