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Emergent Endovascular Repair For Primary Aortoenteric Fistula
Isabel Marques1, Mário Vieira2, Ana Ferreira2
1Serviço de Cirurgia Geral do Hospital de Braga, Portugal.
Summary
A rare case of aortoenteric fistula causing gastrointestinal bleeding was successfully treated with endovascular repair. This minimally invasive approach managed acute bleeding and stabilized the patient, preventing rebleeding.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Gastrointestinal bleeding can be a rare but life-threatening complication of abdominal aortic aneurysms.
- Primary aortoenteric fistulas are uncommon, often presenting with obscure gastrointestinal bleeding and hemodynamic instability.
Observation:
- A 64-year-old male with cardiac comorbidities presented with recurrent gastrointestinal bleeding, culminating in massive hematemesis, anemia, and hypotension.
- Standard upper endoscopy was inconclusive; however, computed tomography (CT) revealed an infrarenal abdominal aortic aneurysm with adjacent fat stranding, suggesting an aortoenteric fistula.
Findings:
- An emergent endovascular repair was successfully performed to address the presumed primary aortoenteric fistula.
- Post-procedure imaging (CT scans and endoscopies) confirmed the control of the enteric lesion and effective management of the fistula.
Implications:
- Endovascular repair offers a viable, minimally invasive option for managing acute, hemodynamically unstable aortoenteric fistulas.
- Prompt diagnosis and intervention are crucial for improving outcomes in patients with this rare but critical condition.
- This case highlights the importance of considering aortoenteric fistula in patients with unexplained gastrointestinal bleeding and aortic pathology.
