Aortoenteric fistula identified by clinical ultrasound

Aortoenteric fistula is a rare but serious cause of gastrointestinal bleeding. Early diagnosis and definitive treatment with fistula repair may improve patient outcomes. We report the use of point-of-care ultrasound to identify an aortoenteric fistula in a patient presenting with abdominal pain and shock.

A 78-year old man presented to the Emergency Department with abdominal pain and 5 days of minimal hematochezia. He was hypotensive and had diffuse abdominal tenderness. Point-of-care ultrasound was performed, demonstrating an abdominal aortic aneurysm with a hypoechoic projection into a segment of bowel abutting the aorta. Color flow was present through the structure, consistent with an aortoenteric fistula. After resuscitation with red blood cells, computed tomography was performed to confirm the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinical ultrasound has a well-established role in the detection of aortic aneurysm. This case illustrates that point-of-care ultrasound can also be used to rapidly identify an aortoenteric fistula and expedite timely care and surgical evaluation.