https://wikem.org/w/index.php?action=history&feed=atom&title=Aortoenteric_fisulta%2FenAortoenteric fisulta/en - Revision history2026-04-20T01:28:05ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Aortoenteric_fisulta/en&diff=379854&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T20:45:54Z<p>Updating to match new version of source page</p>
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==Background==<br />
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*Fistula formed between aorta and intestines<br />
**Can be primary or secondary (often due to [[Special:MyLanguage/AAA|AAA]] repair)<br />
**Can form fistula anytime within life of [[Special:MyLanguage/AAA|AAA]] graft repair<br />
***Higher risk with recent graft placement<br />
*Involves the duodenum (ADF) in most cases<ref>Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.</ref><br />
*Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%<br />
*Mortality of 100% if left untreated<br />
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==Clinical Features==<br />
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*Classic triad: [[Special:MyLanguage/abdominal pain|abdominal pain]], [[Special:MyLanguage/GI bleeding|GI bleeding]] and pulsatile abdominal mass <br />
**Present in 23% of patients<br />
*Low grade [[Special:MyLanguage/fever|fever]]<br />
*[[Special:MyLanguage/Abdominal pain|Abdominal pain]]<br />
*[[Special:MyLanguage/Back pain|Back pain]]<br />
*History of [[Special:MyLanguage/AAA|AAA]] graft<br />
*[[Special:MyLanguage/BRBPR|BRBPR]] or [[Special:MyLanguage/melena|melena]]<br />
**Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed<br />
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==Differential Diagnosis==<br />
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{{UGIB DDX}}<br />
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{{Lower GI bleeding DDX}}<br />
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==Evaluation==<br />
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[[File:AortoEntericFistulaDissectionMark.png|thumb|Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.]]<br />
[[File:PMC4393498 Iranjradiol-12-02-22759-g001.png|thumb|Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.]]<br />
'''If suspicion high, involve vascular surgery early'''<br />
*CBC<br />
*Chem 10<br />
*Type and Cross<br />
*PT/INR/PTT<br />
*Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)<br />
*[[Special:MyLanguage/Aortic ultrasound|Aortic ultrasound]] and [[Special:MyLanguage/FAST exam|FAST exam]] to assess for AAA and Free Fluid<br />
*[[Special:MyLanguage/CXR|CXR]] for pre-op, if patient stable<br />
*[[Special:MyLanguage/ECG|ECG]] for pre-op<br />
*CTA of abdomen/pelvis, highly sensitive, if patient stable<br />
*Patient may need gastroduodenal endoscopy<br />
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==Management==<br />
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*[[Special:MyLanguage/Fluid resuscitation|Fluid resuscitation]]<br />
*Transfuse [[Special:MyLanguage/pRBCs|pRBCs]] as needed<br />
*Surgical Intervention<br />
**Transfer if not available<br />
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==Disposition==<br />
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*Admission<br />
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==External Links==<br />
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==References==<br />
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<references/><br />
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[[Category:GI]]<br />
[[Category:Vascular]]<br />
[[category:Surgery]]</div>FuzzyBot