Primary aorto-enteric fistula: A rare complication of abdominal aortic aneurysm
A 70-year-old lady presented with recurrent gastrointestinal bleeding and septicemia caused by multiple enteric pathogens. She was diagnosed to have primary aorto-enteric fistula (PAEF) complicating abdominal aortic aneurysm. Endovascular aneurysm repair was carried out that arrested gastrointestina...
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Veröffentlicht in: | Journal of postgraduate medicine (Bombay) 2010-10, Vol.55 (4) |
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Sprache: | eng |
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Zusammenfassung: | A 70-year-old lady presented with recurrent gastrointestinal bleeding
and septicemia caused by multiple enteric pathogens. She was diagnosed
to have primary aorto-enteric fistula (PAEF) complicating abdominal
aortic aneurysm. Endovascular aneurysm repair was carried out that
arrested gastrointestinal bleeding, but despite prolonged antibiotic
therapy the patient died a month later of probable sepsis. PAEF refers
to abnormal communication between the aorta and the intestine resulting
from disease at either site; this rare condition should be suspected in
patients with abdominal aortic aneurysm who present with unexplained
life-threatening gastrointestinal bleeding. Computerized tomography is
the most sensitive investigation. Presence of ectopic gas adjacent to
or within the aorta and of contrast within the gastrointestinal tract
is the pathognomonic finding. Definitive treatment consists of surgical
intervention, but it is associated with high risk in the acute setting.
Endovascular therapy using stent-grafts is safe and effective in
arresting gastrointestinal bleeding. However, it is frequently
associated with recurrent sepsis even with continued antibiotic
therapy, and should be considered as a bridge to more definitive
surgical repair at a later time, after optimization of the
patient′s condition. |
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ISSN: | 0022-3859 |