Objective
Misdiagnosis of primary aortoenteric fistula (PAEF) frequently occurs in clinical
practice owing to the rarity of this condition. Herein we present the experience of
diagnosis and management for PAEF.
Methods
Eighteen patients with PAEF at 2 medical centers in China were reviewed. The clinical
data, diagnostic procedures, treatment options, and patient outcomes were evaluated.
Results
The fistulas were located at esophagus (5), duodenum (8), jejunum (3), ileum (1),
and transverse colon (1). The etiologies include atherosclerotic aneurysms and foreign
body. Typical abdominal triad (pain, upper GI bleeding, and abdominal pulsating mass)
was found in 27.8% of patients, and Chiari’s triad (mid-thoracic pain, sentinel hemorrhage,
and massive bleeding after a symptom-free interval) was present in 3 of 5 cases with
thoracic aortoesophageal fistulas. All patients had an average of 3.6 (1-9) episodes
of gastrointestinal bleeding. The interval between the first sentinel hemorrhage and
ultimate exsanguination ranged from 5 hours to 5 months (median, 4 days). Six patients
(33.3%) were diagnosed or suggested by diagnostic tools including endoscopy, computerized
tomography, and arteriography. Others were diagnosed by surgical exploration (7) and
autopsy (5). One to 5 rounds (mean 1.8) of misdiagnosis occurred in 15 patients. Six
patients recovered from surgery and remained well during a 36-month follow-up. The
surgical options used included in situ replacement with vascular graft (3), aneurysmorraphy
and closure of fistula (1), and endovascular stenting (2).
Conclusions
A high index of suspicion is necessary for correct diagnosis and prompt management
of PAEF, especially in patients with aortoiliac aneurysms presenting with gastrointestinal
bleeding. In situ graft replacement and endovascular stent-graft may be the preferred
therapeutic options.
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Article info
Publication history
Published online: November 05, 2007
Accepted:
June 30,
2007
Footnotes
Supported by Institutional Funding from PAL Hospital, China.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
