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Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding
Sylvester Paulasir1, Rhami Khorfan1, Christina Harsant1
1Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA.
BMJ Case Reports
|April 28, 2017
Summary
A rare fistula between the jejunum and an abdominal aortic aneurysm (AAA) caused massive upper gastrointestinal bleeding. This case highlights the importance of considering unusual causes for severe gastrointestinal hemorrhage.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Pathology
Background:
- Massive upper gastrointestinal bleeding (UGIB) presents a diagnostic challenge.
- Abdominal aortic aneurysms (AAA) are typically associated with different complications.
Observation:
- A 68-year-old male presented with shock and hematemesis.
- Initial endoscopic and angiographic evaluations failed to identify the bleeding source.
- Despite interventional radiology procedures, massive UGIB recurred.
Findings:
- Exploratory laparotomy was performed due to persistent, unidentified bleeding.
- Autopsy revealed a previously unknown abdominal aortic aneurysm (AAA) with a fistula to the proximal jejunum.
- This rare aortoenteric fistula was the cause of the fatal gastrointestinal hemorrhage.
Implications:
- This case underscores the necessity of a broad differential diagnosis for obscure UGIB.
- Rare causes, such as aortoenteric fistulas secondary to AAAs, should be considered in refractory cases.
- Early recognition and management of such rare vascular complications are critical.
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