Type:
Educational Exhibit
Keywords:
Not applicable, Haemorrhage, Fistula, Acute, Diagnostic procedure, CT-Angiography, CT, Emergency, Cardiovascular system, Abdomen, Vascular
Authors:
J. Badiola Molinuevo, J. Burgos Ruiz, A. Luis Fernández, A. Serdio, M. Gredilla, K. Biurrun Mancisidor; Donostia - San Sebastián/ES
DOI:
10.26044/ecr2020/C-08353
Background
An aortoenteric fistula (AEF) is a communication between the aorta and the gastrointestinal tract. Gastrointestinal bleeding is the most common clinical presentation, which can be minor in early phases followed by a massive hemorrhage in later phases. Other symptoms that may be present include sepsis and abdominal pain.
It is a rare entity with a nonspecific clinical presentation that requires a high index of suspicion for diagnosis and a mortality rate as high as 86% if left untreated. Early diagnosis and management is essential for improving the prognosis of this entity.
There are two types of aortoenteric fistulas. Primary aortoenteric fistulas (PAEF) occur in patients with no history of aortic reconstruction. Secondary aortoenteric fistulas (SAEF) are far more common and occur in patients who have undergone aortic surgery, with or without placement of an aortic graft or stent.
The bowel segments most commonly involved in aortoenteric fistulas are the third and fourth portion of the duodenum, which represent 80% of the cases.
The cause of this entity is not entirely known. It is thought that a combination of chronic infection of the aortic wall (in primary AEF) or the aortic graft or stent (in secondary AEF) and the long standing pressure of repetitive aortic pulsations cause the erosion of the bowel wall, which ultimately leads to formation of the fistula.