Primary aorto-enteric fistula diagnosed by double-balloon endoscopy

Area of Science:

• Gastroenterology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Primary aorto-enteric fistula (PAEF) is a rare but life-threatening complication of abdominal aortic aneurysms (AAAs).
• PAEF involves a direct rupture of the bowel by an AAA, distinct from secondary fistulas.
• Duodenal involvement is most common, but jejunal and ileal cases also occur.

Purpose of the Study:

• To report a rare case of primary aorto-enteric fistula presenting as gastrointestinal bleeding.
• To emphasize the diagnostic challenges and the role of advanced endoscopic techniques.
• To highlight the importance of considering PAEF in patients with AAA and unexplained GI hemorrhage.

Main Methods:

• An 82-year-old female patient presented with severe hematemesis and hematochezia.
• Initial upper and lower endoscopies were inconclusive.
• Antegrade double-balloon endoscopy identified a jejunal submucosal tumor-like protuberance with an ulcer.
• Computed tomography (CT) confirmed free air near the AAA, indicating PAEF.

Main Results:

• The patient was diagnosed with a primary aorto-enteric fistula.
• An abdominal aortic stent graft was successfully implanted, followed by laparotomy.
• Intraoperative findings revealed adhesions between the AAA and the small intestinal wall.
• The patient experienced an uneventful postoperative recovery with no recurrence.

Conclusions:

• PAEF should be considered in patients with a history of AAA presenting with gastrointestinal bleeding.
• Endoscopic findings, such as submucosal tumor-like protuberances, can be indicative of PAEF and should not be misdiagnosed.
• Timely diagnosis and intervention are critical for favorable patient outcomes in PAEF cases.