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A RARE REASON FOR GASTROINTESTINAL SYSTEM BLEEDING: AORTOENTERIC FISTULA

Year 2018, Volume: 32 Issue: 3, 259 - 264, 15.12.2018

Mehtap Şahin , Dilek Güney Esra Güngör Albayrak

Abstract

Aorto-enteric fistula is a rare clinical picture with a high incidence
of mortality among causes of gastrointestinal bleeding. Aorto-enteric fistulas,
seen as primary or secondary, develop most frequently after aortic graft
operation. Anamnesis plays a very important role in the diagnosis of
aorto-enteric fistula since it is at first an unsuspected cause of gastrointestinal
bleeding.



In this article, we report a case of a 75-year-old male patient with
gastrointestinal bleeding in whom the bleeding focus could not be determined
despite repeated endoscopies. The diagnosis of aortic dissection and
aorto-enteric fistula was achieved following CT angiography and aortic graft
sheath CT. 

Keywords

Gastrointestinal bleeding aortic dissection aorto-enteric fistula

References

  • Hauser SC. Gastrointestinal Sistemin Vasküler Hastalıkları. İçinde: Goldman L, Schafer AI. Cecil Medicine. Çev. Ed. Ünal S. Ankara, Güneş Tıp Kitapevi; 2011: s.1068.
  • Tuncer MM. Gastrointestinal Sistem Kanamaları. İçinde: Altıparmak MR, Hamuryudan V, Sonsuz A, Yazıcı H. Cerrahpaşa İç Hastalıkları. 2. Baskı, İstanbul, İstanbul Tıp Kitapevi; 2012, s.1008
  • Uzunismail H. Gastrointestinal Kanamalar İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri İç Hastalıklarında Aciller Sempozyum Dizisi No: 29, Mart 2002; s. 181-190
  • Cutler JA, Mendeloff AI. Upper gastrointestinal bleeding. Nature and magnitude of the problem in the U.S. Dig Dis Sci 1981; 26: 90S – 96S.
  • ASGE Standards of Practice Committee, Pasha SF, Shergill A, Acosta RD, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc. 2014; 79: 875–885.
  • Okazaki H, Fujiwara Y, Sugimori S, Nagami Y, Kameda N, Machida H, et al. Prevalence of mid-gastro-intestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients. J Gastroenterol. 2009; 44: 550–555.
  • Pınarbaşı B, Kaymakoğlu S. Gastrointestinal Sistem Kanamalarına Yaklaşım. Dahili Tıp Bilimleri Dergisi 2005; 12: 117-129.
  • Nakamura T, Terano A. Capsule endoscopy: past, present, and future. J Gastroenterol. 2008; 43: 93–9.
  • Başer M, Arslantürk H, Kisli E, Arslan M, Oztürk T, Uygan I, Kotan C. Primary aortoduodena lfistula due to a swallowedsewingneedle: a rare cause of gastrointestina lbleeding. Ulus Travma Acil Cerrahi Derg 2007; 13: 154-7.
  • CHO YP, et al. Staged surgery for chronic primary aortoduodenal fistula in a septic patient. J Korean Med Sci, 2004, 19: 302-304.
  • Paksoy M. Gastrointestinal Sistem Kanamalarında Cerrahi Tedavi İÜ. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Gastrointestinal Sistem Hastalıkları Sempozyumu 11-12 Ocak 2001, İstanbul, s. 309-319
  • Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A,Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review.J Vasc Surg 2009; 49: 7829.
  • Cendan JC, Thomas JB, Seeger JM. Twenty-one cases of aortoenteric fistula: Lessons for the general surgeon. Am Surg 2004; 70: 5837.
  • Luo CY, Lai CH, Wen JS, Lin BW. Secondary aortocolic fistula: case report and review of the literature. Ann Vasc Surg 2010;24:256.e5-12.
  • Senadhi V, Brown JC, Arora D, Shaffer R, Shetty D, Mackrell P. A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula. Case Rep Gastroenterol 2010;4:510-517.
  • Armstrong PA et al. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg. 2005,42:660-666.
  • Temizkan V, Uğur M, Alp İ, Uçak A, Yılmaz AT. Sekonder aortoenterik fistül. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2013;21:1150-1151.
  • Vu QD, Menias CO, Bhalla S et-al. Aortoenteric fistulas: CT features and potential mimics. Radiographics.2009;29:197-209.
  • Shehzad KL, Riaz A, Meyrick-Thomas J. Primary aortoduodenal fistula – a rare clinical entity. J R Soc Med Sh Rep. 2010;1:7. Peck JJ, Eidemiller LR. Aortoenteric fistulas. Arch Surg. 1992; 127: 1191–3; discussion 1193–1194.
  • Saers SJ, Scheltinga MR. Primary aorto-enteric fistula. Br J Surg. 2005;92:143–52
  • Tareen AH, Schroeder TV. Primary aortoenteric fistula: two new case reports and a review of 44 previously reported cases. Eur J Vasc Endovasc Surg. 1996; 12: 5–10.
  • Champion MC, Sullivan SN, Coles JC, Goldbach M, Watson WC. Aortoenteric fistula. Incidence, presentation recognition, and management. Ann Surg 1982; 195: 31417.
  • Armstrong PA, Back MR, Wilson JS, Shames ML, Johnson BL, Bandyk DF. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg 2005; 42: 6606.
  • Biro G, Szabo G, Fehervari M, Munch Z, Szeberin Z,Acsady G. Late outcome following open surgical management of secondary aortoenteric fistula. Langenbecks Arch Surg 2011; 396: 12219.
  • Bissacco D, Freni L, Attisani L, Barbetta I, Dallatana R, Settembrini R. Unusual clinical presentation of primary aortoduodenal fistula. Gastroenterol Rep. 2015; 170-174.
  • Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005; 92: 143–52.
  • Finch L, Heathcock RB, Quigley T, Jiranek G,Robinson D. Emergent treatment of a primary aortoenteric fistula with N-butyl 2-cyanoacrylate and endovascular stent. J Vasc Interv Radiol. 2002; 13: 841–3.
  • Xiromeritis K, Dalainas I, Stamatakos M, Filis K. Aortoenteric fistulae: Present-day management. Int Surg 2011; 96: 26673.
  • Herdrich BJ, Fairman RM. How to manage infected aortic endografts. J Cardiovasc Surg (Torino) 2013; 54: 595604.
  • Low RN, Wall SD, Jeffrey RB, Sollitto RA, Reilly LM, Tierney LM. Aortoenteric fistula and perigraft infection: Evaluation with CT. Radiology 1990; 175: 15762.
  • Sharif MA, Lee B, Lau LL, Ellis PK, Collins AJ, Blair PH, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2007; 46: 4428.
  • Maternini M, Tozzi P, Vuilleumier H, Von Segesser LK. Intravascular ultra sound: One more tool to diagnose aortoduodenal fistula. Eur J Vasc Endovasc Surg 2006; 32: 5424.
  • Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A, Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review. J Vasc Surg 2009;49:782-9
  • Hohman D, Noghrehkar D, Sorensen V, Taylor E. Primary Aortoduodenal Fistula. The Internet Journal of Internal Medicine. 2008; 8: 1.
  • Jolanta, Šumskienė, et al. Aorto-duodenal fistula: a rare but serious complication of gastrointestinal hemorrhage. A case report. Acta Medica Lituanica, 2016, 23.3: 165.
  • Moulton S, Adams M, Johansen K. Aortoenteric fistula. A 7 year urban experience. Am J Surg 1986; 151: 60711.
  • Malik, Mohammad U.; Ucbilek, Enver; Sherwal, Amanpreet S. Critical gastrointestinal bleed due to secondary aortoenteric fistula. Community Hosp Intern Med Perspect, 2015, 5.6: 29677.

Gastrointestinal Sistem Kanamalarının Nadir Bir Nedeni: Aorto-enterik Fistül

Year 2018, Volume: 32 Issue: 3, 259 - 264, 15.12.2018

Mehtap Şahin , Dilek Güney Esra Güngör Albayrak

Abstract

Aorto-enterik fistül, gastrointestinal
sistem kanama nedenleri arasında nadir görülen, mortalitesi yüksek olan klinik
bir tablodur. Primer veya sekonder olarak görülen aorto-enterik fistüller en
sık aort grefti operasyonu sonrasında gelişmektedir. Gastrointestinal kanamalı
hastanın tanısında ilk olarak akla gelmeyen bu tablonun tanısında anamnez çok
önemli bir rol oynamaktadır.



Bu makalede tekrarlanan endoskopilere
rağmen kanama odağı belirlenemeyen, aort grefti öykülü, batın CT-anjiografi ve
operasyon sonrasında aort disseksiyonu ve aorto-enterik fistül tanısı saptanan
gastrointestinal kanamalı 75 yaşında bir erkek hasta sunulmaktadır.

Keywords

Gastrointestinal kanama aort diseksiyonu aorto-enterik fistül

References

  • Hauser SC. Gastrointestinal Sistemin Vasküler Hastalıkları. İçinde: Goldman L, Schafer AI. Cecil Medicine. Çev. Ed. Ünal S. Ankara, Güneş Tıp Kitapevi; 2011: s.1068.
  • Tuncer MM. Gastrointestinal Sistem Kanamaları. İçinde: Altıparmak MR, Hamuryudan V, Sonsuz A, Yazıcı H. Cerrahpaşa İç Hastalıkları. 2. Baskı, İstanbul, İstanbul Tıp Kitapevi; 2012, s.1008
  • Uzunismail H. Gastrointestinal Kanamalar İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri İç Hastalıklarında Aciller Sempozyum Dizisi No: 29, Mart 2002; s. 181-190
  • Cutler JA, Mendeloff AI. Upper gastrointestinal bleeding. Nature and magnitude of the problem in the U.S. Dig Dis Sci 1981; 26: 90S – 96S.
  • ASGE Standards of Practice Committee, Pasha SF, Shergill A, Acosta RD, Chandrasekhara V, Chathadi KV, et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc. 2014; 79: 875–885.
  • Okazaki H, Fujiwara Y, Sugimori S, Nagami Y, Kameda N, Machida H, et al. Prevalence of mid-gastro-intestinal bleeding in patients with acute overt gastrointestinal bleeding: multi-center experience with 1,044 consecutive patients. J Gastroenterol. 2009; 44: 550–555.
  • Pınarbaşı B, Kaymakoğlu S. Gastrointestinal Sistem Kanamalarına Yaklaşım. Dahili Tıp Bilimleri Dergisi 2005; 12: 117-129.
  • Nakamura T, Terano A. Capsule endoscopy: past, present, and future. J Gastroenterol. 2008; 43: 93–9.
  • Başer M, Arslantürk H, Kisli E, Arslan M, Oztürk T, Uygan I, Kotan C. Primary aortoduodena lfistula due to a swallowedsewingneedle: a rare cause of gastrointestina lbleeding. Ulus Travma Acil Cerrahi Derg 2007; 13: 154-7.
  • CHO YP, et al. Staged surgery for chronic primary aortoduodenal fistula in a septic patient. J Korean Med Sci, 2004, 19: 302-304.
  • Paksoy M. Gastrointestinal Sistem Kanamalarında Cerrahi Tedavi İÜ. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Gastrointestinal Sistem Hastalıkları Sempozyumu 11-12 Ocak 2001, İstanbul, s. 309-319
  • Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A,Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review.J Vasc Surg 2009; 49: 7829.
  • Cendan JC, Thomas JB, Seeger JM. Twenty-one cases of aortoenteric fistula: Lessons for the general surgeon. Am Surg 2004; 70: 5837.
  • Luo CY, Lai CH, Wen JS, Lin BW. Secondary aortocolic fistula: case report and review of the literature. Ann Vasc Surg 2010;24:256.e5-12.
  • Senadhi V, Brown JC, Arora D, Shaffer R, Shetty D, Mackrell P. A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula. Case Rep Gastroenterol 2010;4:510-517.
  • Armstrong PA et al. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg. 2005,42:660-666.
  • Temizkan V, Uğur M, Alp İ, Uçak A, Yılmaz AT. Sekonder aortoenterik fistül. Türk Göğüs Kalp Damar Cerrahisi Dergisi 2013;21:1150-1151.
  • Vu QD, Menias CO, Bhalla S et-al. Aortoenteric fistulas: CT features and potential mimics. Radiographics.2009;29:197-209.
  • Shehzad KL, Riaz A, Meyrick-Thomas J. Primary aortoduodenal fistula – a rare clinical entity. J R Soc Med Sh Rep. 2010;1:7. Peck JJ, Eidemiller LR. Aortoenteric fistulas. Arch Surg. 1992; 127: 1191–3; discussion 1193–1194.
  • Saers SJ, Scheltinga MR. Primary aorto-enteric fistula. Br J Surg. 2005;92:143–52
  • Tareen AH, Schroeder TV. Primary aortoenteric fistula: two new case reports and a review of 44 previously reported cases. Eur J Vasc Endovasc Surg. 1996; 12: 5–10.
  • Champion MC, Sullivan SN, Coles JC, Goldbach M, Watson WC. Aortoenteric fistula. Incidence, presentation recognition, and management. Ann Surg 1982; 195: 31417.
  • Armstrong PA, Back MR, Wilson JS, Shames ML, Johnson BL, Bandyk DF. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg 2005; 42: 6606.
  • Biro G, Szabo G, Fehervari M, Munch Z, Szeberin Z,Acsady G. Late outcome following open surgical management of secondary aortoenteric fistula. Langenbecks Arch Surg 2011; 396: 12219.
  • Bissacco D, Freni L, Attisani L, Barbetta I, Dallatana R, Settembrini R. Unusual clinical presentation of primary aortoduodenal fistula. Gastroenterol Rep. 2015; 170-174.
  • Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005; 92: 143–52.
  • Finch L, Heathcock RB, Quigley T, Jiranek G,Robinson D. Emergent treatment of a primary aortoenteric fistula with N-butyl 2-cyanoacrylate and endovascular stent. J Vasc Interv Radiol. 2002; 13: 841–3.
  • Xiromeritis K, Dalainas I, Stamatakos M, Filis K. Aortoenteric fistulae: Present-day management. Int Surg 2011; 96: 26673.
  • Herdrich BJ, Fairman RM. How to manage infected aortic endografts. J Cardiovasc Surg (Torino) 2013; 54: 595604.
  • Low RN, Wall SD, Jeffrey RB, Sollitto RA, Reilly LM, Tierney LM. Aortoenteric fistula and perigraft infection: Evaluation with CT. Radiology 1990; 175: 15762.
  • Sharif MA, Lee B, Lau LL, Ellis PK, Collins AJ, Blair PH, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2007; 46: 4428.
  • Maternini M, Tozzi P, Vuilleumier H, Von Segesser LK. Intravascular ultra sound: One more tool to diagnose aortoduodenal fistula. Eur J Vasc Endovasc Surg 2006; 32: 5424.
  • Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A, Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review. J Vasc Surg 2009;49:782-9
  • Hohman D, Noghrehkar D, Sorensen V, Taylor E. Primary Aortoduodenal Fistula. The Internet Journal of Internal Medicine. 2008; 8: 1.
  • Jolanta, Šumskienė, et al. Aorto-duodenal fistula: a rare but serious complication of gastrointestinal hemorrhage. A case report. Acta Medica Lituanica, 2016, 23.3: 165.
  • Moulton S, Adams M, Johansen K. Aortoenteric fistula. A 7 year urban experience. Am J Surg 1986; 151: 60711.
  • Malik, Mohammad U.; Ucbilek, Enver; Sherwal, Amanpreet S. Critical gastrointestinal bleed due to secondary aortoenteric fistula. Community Hosp Intern Med Perspect, 2015, 5.6: 29677.
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Mehtap Şahin 0000-0001-8495-2858

Dilek Güney This is me

Esra Güngör Albayrak This is me

Publication Date December 15, 2018
Submission Date July 28, 2017
Published in Issue Year 2018 Volume: 32 Issue: 3

Cite

Vancouver Şahin M, Güney D, Güngör Albayrak E. Gastrointestinal Sistem Kanamalarının Nadir Bir Nedeni: Aorto-enterik Fistül. DEU Tıp Derg. 2018;32(3):259-64.
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