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Secondary aortoenteric fistula: active bleeding detected with multi-detector-row CT
Justus E Roos1, Jürgen K Willmann, Paul R Hilfiker
1Institute of Diagnostic Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zurich, Switzerland.
European Radiology
|January 11, 2003
Summary
Multi-detector-row CT angiography (MDCT) successfully diagnosed active bleeding from a secondary aortoenteric fistula (SAEF) when other methods failed. MDCT imaging visualized the fistula and bleeding dynamics, proving valuable for SAEF assessment.
Area of Science:
- Radiology
- Vascular Surgery
- Gastroenterology
Background:
- Secondary aortoenteric fistula (SAEF) is a rare but life-threatening complication following aortic graft surgery.
- Diagnosing active SAEF bleeding can be challenging, often requiring multiple imaging modalities.
Observation:
- A patient presented with active bleeding from a suspected SAEF.
- Initial investigations including catheter angiography and endoscopy were inconclusive.
- Multi-detector-row CT (MDCT) angiography was performed for definitive diagnosis.
Findings:
- MDCT angiography clearly delineated the fistulous tract between the abdominal aortic graft and the duodenum.
- Dynamic imaging during MDCT confirmed active bleeding through increased contrast accumulation in the duodenum across different phases.
- The 3D image quality of MDCT proved superior for visualizing the complex anatomy.
Implications:
- MDCT angiography is a highly valuable tool for diagnosing active SAEF bleeding, especially when other methods are negative.
- This case highlights the utility of advanced CT techniques in managing complex vascular and gastrointestinal emergencies.
- Improved diagnostic accuracy can lead to timely intervention and better patient outcomes in SAEF cases.