Korean J Gastroenterol.  2013 Jun;61(6):343-346. 10.4166/kjg.2013.61.6.343.

A Case of Primary Aortoenteric Fistula Mimicking Ulcer Bleeding

• Kim JS
• Han JH
• Kang MH
• Choi YR
• Chae HB
• Park SM
• Youn SJ

• KMID: 1718067
• DOI: http://doi.org/10.4166/kjg.2013.61.6.343

Abstract

Primary aortoenteric fistula (PAEF) is a rare disease with a high mortality rate due to massive hemorrhaging and diagnostic difficulties. Although hemorrhagic regions can be identified by endoscopy, it is difficult to diagnose PAEF by this method. If PAEF is suspected, endoscopic procedure should be terminated and abdominal CT should be performed. Overlooking the herald bleeding of PAEF can lead to massive bleeding and death. An 85-year-old previously healthy male presented with a complaint of melena. Gastrointestinal endoscopy identified a hemorrhagic site in the third portion of the duodenum and endoscopic hemostasis was performed. However, during the procedure, it became apparent that the hemorrhage was probably not the result of a simple duodenal ulceration and abdominal CT was performed immediately. An aortic aneurysm connected to the duodenum was identified, confirming the diagnosis of PAEF. However, the patient died of massive hemorrhaging before an operation could be performed.

Keyword

Aortic aneurysm, abdominal; Intestinal fistula; Gastrointestinal hemorrhage; Endoscopic hemostasis

MeSH Terms

Aged, 80 and over
Aortic Aneurysm, Abdominal/*diagnosis/pathology
Diagnosis, Differential
Endoscopy, Gastrointestinal
Fibrin Tissue Adhesive/therapeutic use
Fistula/*diagnosis/pathology
Gastrointestinal Hemorrhage/diagnosis/therapy
Humans
Male
Tomography, X-Ray Computed
Fibrin Tissue Adhesive

Figure

• 

  Fig. 1. Endoscopic findings. (A) Fresh duodenal bleeding after blood clot removal. (B, C) Continuous bleeding after clipping of the necrotized mucous membrane. (D) Stoppage of the bleeding after fibrin glue injection.

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  Fig. 2. Transverse abdominal CT showing communications between the abdominal aortic aneurysm (about 3.5 cm in diameter) and the third portion of the duodenum (visible hemo clips) (arrows).

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  Fig. 3. Sagittal abdominal CT showing communications between the saccular abdominal aortic aneurysm of the abdominal aorta (lumbar levels 3–4) and the distal duodenum (arrow).

Reference

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