CT of aortoenteric fistulas

Area of Science:

• Radiology
• Vascular Surgery
• Gastroenterology

Background:

• Aortoenteric fistula (AEF) is a rare but life-threatening complication following aortic graft surgery.
• Gastrointestinal bleeding and recurrent sepsis are common clinical presentations of AEF.
• Accurate and timely diagnosis is crucial for patient management and outcomes.

Purpose of the Study:

• To evaluate the diagnostic accuracy of computed tomography (CT) in patients suspected of having an aortoenteric fistula (AEF).
• To compare CT findings with endoscopic, angiographic, and surgical results in diagnosing AEF.
• To determine the utility of CT as an initial imaging modality for suspected AEF.

Main Methods:

• Retrospective review of ten patients with suspected AEF.
• Comparison of CT findings with endoscopic, angiographic, and surgical outcomes.
• Analysis of specific CT indicators of AEF, including perigraft fluid and gas.

Main Results:

• CT correctly diagnosed AEF in six out of ten patients (60%).
• CT findings suggestive of AEF included perigraft fluid (5/6) and/or perigraft gas (4/6) more than three months post-surgery.
• All diagnosed AEF cases had perigraft infections; CT identified perigraft gas and fluid in 50% of these.
• Endoscopy and angiography failed to identify AEF in the evaluated patients.

Conclusions:

• Computed tomography is a valuable tool for diagnosing aortoenteric fistula (AEF).
• CT findings of perigraft fluid and/or gas are significant indicators of AEF.
• CT should be considered the primary imaging modality for suspected AEF in hemodynamically stable patients.