Aortoenteric Fistula: A Rare Cause of Gastrointestinal Bleeding

1University of Illinois, Urbana‐Champaign, IL

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 311

Case Presentation:

A 55‐year‐old African American man with a medical history of abdominal aortic aneurysm repair with aortobiiliac reconstruction was admitted with a chief complaint of dark‐colored stools and fever. On examination, abdominal bruits were heard. An aortoenteric fistula was suspected and an upper endoscopy was performed; this revealed graft material in the third portion of the duodenum. CT angiogram revealed evidence of biiliac graft infection, findings were consistent with purulent fluid around the graft at the level of third portion of the duodenum. The patient underwent removal of the infected aortobiiliac graft and repair of the duodenum. Blood cultures grew Candida albicans, and his graft material cultures grew Escherichia coli, Candida albicans and anaerobes. He was treated with appropriate antimicrobials and antifungals. He had a prolonged hospitalization but was discharged in stable condition.

Discussion:

Aortoenteric fistula (AEF), due to mechanical erosion or infection of a prosthetic graft, is a rare cause of gastrointestinal bleeding and an uncommon complication of abdominal aortic aneurysm repair. The most frequent presenting feature is upper GI bleeding, which can range from a minor “herald” bleed to exsanguinating hemorrhage. Occasionally, AEF may manifest with atypical, nonspecific symptoms such as fever, sepsis, or unexplained abdominal pain. Delay in diagnosis is common. Clinicians should maintain a high index of suspicion to avoid potentially lethal outcomes. When a patient with a prior abdominal aortic graft develops abdominal pain, GI bleeding, or sepsis, the presence of a fistula should be considered.

Conclusions:

Aortoenteric fistula is a rare cause of gastrointestinal bleeding with a high mortality rate. It should be included in the differential diagnosis of patients who have a history of abdominal aortic aneurysm repair. A high index of suspicion is needed to identify and appropriately manage aortoenteric fistula.

To cite this abstract:

Vegunta R. Aortoenteric Fistula: A Rare Cause of Gastrointestinal Bleeding. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 311. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/aortoenteric-fistula-a-rare-cause-of-gastrointestinal-bleeding/. Accessed September 16, 2019.

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