Aortoenteric fistula diagnosed by double balloon enteroscopy: a case report

Area of Science:

• Vascular Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Secondary aortoenteric fistula (AEF) is a rare but life-threatening complication following aortic surgery, particularly aortic graft operations.
• It involves an abnormal connection between the gastrointestinal tract and the aorta.
• Patients often present with gastrointestinal bleeding, mimicking other common causes.

Purpose of the Study:

• To report a case of secondary aortoenteric fistula (AEF) in a patient with a history of abdominal aortic aneurysm repair.
• To highlight the diagnostic challenges and the utility of double balloon enteroscopy in identifying the bleeding source.
• To emphasize the importance of timely diagnosis and surgical management for favorable outcomes.

Main Methods:

• A patient with a history of abdominal aortic aneurysm graft interposition presented with recurrent hematemesis and hematochezia.
• Standard diagnostic procedures including gastroscopy, colonoscopy, and radioactive iodine scan were performed but failed to localize the bleeding.
• Diagnosis was established using double balloon enteroscopy, which visualized the aortoenteric fistula.

Main Results:

• Initial endoscopic and imaging studies were inconclusive in identifying the cause of severe gastrointestinal bleeding.
• Double balloon enteroscopy provided definitive diagnosis of a secondary aortoenteric fistula.
• The patient recovered successfully following surgical intervention to repair the fistula.

Conclusions:

• Secondary aortoenteric fistula is a critical diagnosis in patients with a history of aortic surgery presenting with obscure gastrointestinal bleeding.
• Double balloon enteroscopy is a valuable tool for diagnosing AEF when conventional methods fail.
• Prompt surgical management is essential for successful treatment and patient recovery.