Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2021.301
Autopsy and Case Reports
Autopsy Case Report

Primary aortoduodenal fistula: a rare cause of massive gastrointestinal hemorrhage

George St. Stoyanov; Deyan Dzhenkov; Lilyana Petkova

Downloads: 1
Views: 77

Abstract

  Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.

Keywords

Pathology, Autopsy, Aortic Aneurysm, Digestive System Fistula

References

1 Šumskienė J, Šveikauskaitė E, Kondrackienė J, Kupčinskas L. Aorto-duodenal fistula: a rare but serious complication of gastrointestinal hemorrhage. A case report. Acta Med Litu. 2016;23(3):165-8. http://dx.doi.org/10.6001/actamedica.v23i3.3380. PMid:28356804.

2 Alzobydi AH, Guraya SS. Primary aortoduodenal fistula: a case report. World J Gastroenterol. 2013;19(3):415-7. http://dx.doi.org/10.3748/wjg.v19.i3.415. PMid:23372367.

3 Busuttil SJ, Goldstone J. Diagnosis and management of aortoenteric fistulas. Semin Vasc Surg. 2001;14(4):302-11. http://dx.doi.org/10.1053/svas.2001.27888. PMid:11740838.

4 Lin TC, Tsai CL, Chang YT, Hu SY. Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report. BMC Cardiovasc Disord. 2018;18(1):113. http://dx.doi.org/10.1186/s12872-018-0852-y. PMid:29879911.

5 Reckless JPD, McColl I, Taylor GW. Aorto‐enteric fistulae: an uncommon complication of abdominal aortic aneurysms. Br J Surg. 1972;59(6):458-60. http://dx.doi.org/10.1002/bjs.1800590613. PMid:4537432.

6 Peck JJ, Eidemiller LR. Aortoenteric fistulas. Arch Surg. 1992;127(10):1191-3. http://dx.doi.org/10.1001/archsurg.1992.01420100049008. PMid:1417484.

7 Fontana M, Tonelli R, Gozzi F, et al. An uncommon cause of hemoptysis: aortobronchial fistula. Multidiscip Respir Med. 2018;13(1):25. http://dx.doi.org/10.1186/s40248-018-0146-3. PMid:30214723.

8 Walpot J, Klazen C, Hokken R, Sorgedrager J, Hoevenaar M, Braber J. Aorto-right ventricular fistula as an occasional finding. Eur J Echocardiogr. 2005;6(1):65-6. http://dx.doi.org/10.1016/j.euje.2004.08.009. PMid:15664555.

9 Agrawal A, Amor MM, Iyer D, Parikh M, Cohen M. Aortico-left atrial fistula: a rare complication of bioprosthetic aortic valve endocarditis secondary to enterococcus faecalis. Case Rep Cardiol. 2015;2015:473246. http://dx.doi.org/10.1155/2015/627946. PMid:26246917.

10 Ruby BJ, Cogbill TH. Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft. J Vasc Surg. 2007;45(4):834-6. http://dx.doi.org/10.1016/j.jvs.2006.11.039. PMid:17398395.

11 Beuran M, Negoi I, Negoi RI, Hostiuc S, Paun S. Primary aortoduodenal fistula: first you should suspect it. Rev Bras Cir Cardiovasc. 2016;31(3):261-3. http://dx.doi.org/10.5935/1678-9741.20160049. PMid:27737411.

12 Bissacco D, Freni L, Attisani L, Barbetta I, Dallatana R, Settembrini P. Unusual clinical presentation of primary aortoduodenal fistula. Gastroenterol Rep. 2015;3(2):170-4. http://dx.doi.org/10.1093/gastro/gou040. PMid:24982129.

13 Cooper A. The lectures of Sir Astley Cooper on the principles and practice of surgery. Philadelphia: A. Sherman; 1826.

14 Saers SJF, Scheltinga MRM. Primary aortoenteric fistula. Br J Surg. 2005;92(2):143-52. http://dx.doi.org/10.1002/bjs.4928. PMid:15685700.

15 Lemos DW, Raffetto JD, Moore TC, Menzoian JO. Primary aortoduodenal fistula: a case report and review of the literature. J Vasc Surg. 2003;37(3):686-9. http://dx.doi.org/10.1067/mva.2003.101. PMid:12618713.
 


Submitted date:
05/16/2021

Accepted date:
06/04/2021

Publication date:
08/20/2021

611fa7c8a953955a842463d3 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections