Gastrointestinal bleeding due to a primary aortoenteric fistula

Area of Science:

• Vascular Surgery
• Gastroenterology
• Diagnostic Imaging

Background:

• Gastrointestinal bleeding can be life-threatening, necessitating prompt diagnosis and intervention.
• Aortoduodenal fistula is a rare but critical cause of upper gastrointestinal hemorrhage.

Purpose of the Study:

• To report a case of a primary aortoduodenal fistula presenting with severe gastrointestinal bleeding.
• To highlight the diagnostic utility of CT angiography and the effectiveness of endovascular repair.

Main Methods:

• A patient presenting with hematemesis and hypovolemic shock underwent CT angiography.
• Upper gastrointestinal endoscopy identified a large clot but failed to locate the bleeding source.
• The identified primary aorta-duodenal fistula was treated with an endograft and femoro-femoral bypass.

Main Results:

• CT angiography successfully diagnosed a primary aorta-duodenal fistula.
• Endovascular repair using an endograft and femoro-femoral bypass was performed.
• The patient recovered and was discharged 14 days post-admission.

Conclusions:

• CT angiography is crucial for diagnosing rare causes of gastrointestinal bleeding like aortoduodenal fistula.
• Endovascular repair offers a viable treatment option for aortoduodenal fistulas.
• Multidisciplinary management is key in handling complex vascular and gastrointestinal emergencies.