Prımary Aortoenteric Fistula
Elif GŁneysu, Alı Aycan Kavala, Mehmet Atay, Hasan Toz.
Bakırkoy Dr Sadi Konuk Egıtım Arastıma Hastanesı, İSTANBUL, Turkey.
OBJECTIVE: Primary aortoenteric fistulas are a rare cause of gastrointestinal bleeding but are associated with high morbidity and mortality. In this article, we presented a 64-year-old male patient with primary aortoenteric fistula who underwent endovascular stent graft placement.
METHODS: There was no disease other than hypertension in the medical history of the patient who was followed by complaints of hematemesis and hematochezia in general surgical service for 4 days. There was no active bleeding center except for gastritis and duodenal ulcer in the endoscopy and colonoscopy performed during the first hospitalization. An emergency abdominal CT angiography was taken because the hemodynamic instability developed on the 4th day and the hematocrit gradually fell. The patient was consulted us upon that the contrast extravasation at the distal abdominal aorta level and soft tissue density were seen on the abdominal CT angiography . Aortoenteric fistula was considered in the patient with clinical correlation.
RESULTS: The patient was immediately taken to the angiography laboratory. The location of the fistula was determined in the aortography performed under local anesthesia in the patient (Figure 1). The Anaconda stent graft (brand name: vascutek TERUMO) was successfully placed and then it has been observed that the aortoenteric fistula was closed in the aortography (Figure 2). The patient who was followed as stable in the service after the procedure was discharged on the 3rd postoperative day. The hematocrit value of the patient who was called for the control at the first postoperative month was 31.4. No pathology was detected in the contrast-enhanced abdominal CT.
CONCLUSIONS: It is often difficult to diagnose it because there is very little evidence for aortoenteric fistula as a focus in the gastrointestinal bleedings. It is necessary to make a quick decision because it is rare and it is hemodynamically unstable like our case.
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