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Published on: July 11, 2013
Primary aorto-enteric fistula
Andrew C Gordon1, Mayank Agarwal1
1Croydon University Hospital, London, United Kingdom.
Insights
Primary aorto-enteric fistula (PAEF) is a rare condition where the aorta erodes into the intestinal tract. Early recognition of a "herald" bleed is crucial for diagnosis and improved outcomes in patients with upper GI hemorrhage.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Oncology
Background:
- Primary aorto-enteric fistula (PAEF) is a rare and life-threatening condition involving spontaneous erosion between the aorta and intestinal tract.
- Unlike secondary AEF, which follow aortic surgery, primary AEF has a dismal prognosis due to low clinical suspicion and diagnostic challenges.
Purpose of the Study:
- To review the literature on PAEF etiology.
- To present a rare case of PAEF secondary to metastatic retroperitoneal carcinoma.
Main Methods:
- Literature review of PAEF etiology.
- Case report of a 59-year-old female with PAEF secondary to metastatic retroperitoneal carcinoma.
Main Results:
- Identified gallstone erosion, pancreatic carcinoma, and duodenal diverticulum as potential etiologies.
- Presented a unique case of PAEF secondary to metastatic retroperitoneal carcinoma, an extremely rare cause.
Conclusions:
- PAEF requires high clinical suspicion, especially in cases of acute upper GI hemorrhage with no clear cause.
- The presence of a 'herald' bleed may be a significant indicator for diagnosing PAEF.
- Further research is needed due to limited literature on primary AEF compared to secondary AEF.
Introduction:
Primary aorto-enteric fistula (PAEF) is a life threatening, spontaneous erosion and communication of the aorta and intestinal tract. Unlike secondary AEF, which occur following aortic surgery, they are extremely rare. The low clinical suspicion and difficulty in obtaining a definitive diagnosis make for a dismal prognosis.
Case Presentation:
A literature review highlighted aetiology which included gallstone erosion, carcinoma of the pancreas and duodenal diverticulum. With written consent, we present the case of a 59 year old female, brought to the hospital following an episode of haematemesis and later found to have an AEF, secondary to metastatic retroperitoneal carcinoma - an extremely rare aetiology.
Discussion:
There is far less literature on primary AEF when compared to secondary AEF. Furthermore, there is a variation in aetiology. Identifying the presence of a 'herald' bleed appears to be significant.
Conclusion:
Aorto-enteric fistulae must always be considered as a potential diagnosis in the setting of an acute upper GI haemorrhage with no apparent cause.
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