Aortoenteric fistula: diagnosis and management

Area of Science:

• Vascular Surgery
• Gastroenterology
• Infectious Disease

Background:

• Aortoenteric fistulas are rare but life-threatening complications arising from the communication between intra-abdominal vascular prostheses and the gastrointestinal tract.
• This study reviews a decade of experience with 14 patients diagnosed with proven aortoenteric fistulas at a community hospital system.

Observation:

• The primary manifestation observed was massive gastrointestinal hemorrhage, frequently preceded by a "herald bleed."
• When the small bowel (excluding the duodenum) or colon is involved, chronic bleeding and sepsis become characteristic.
• Diagnostic and treatment challenges were highlighted through illustrative case reports.

Findings:

• Intra-abdominal vascular prostheses communicating with the GI tract lead to distinct clinical presentations.
• Massive GI hemorrhage is the most common sign, often following a herald bleed.
• Sepsis and chronic bleeding are prevalent when the small intestine or colon is affected.

Implications:

• Emphasizes the critical need for heightened clinical suspicion in patients with a history of vascular prostheses and GI bleeding.
• Highlights the importance of prompt diagnostic evaluation and multidisciplinary management strategies.
• Suggests that understanding these manifestations can lead to earlier intervention and potentially improved survival rates.