Secondary aorto-duodenal fistula, a rare opportunity to perform a Whipple procedure
Keywords:
aortoenteric fistula, aorta, duodenum, extra anatomical bypass, Whipple procedureAbstract
Aortoenteric fistulas are defined as a communication between the aorta and a portion of the digestive system. This pathology has a 0.04-0.07% incidence with a mortality rate of up to 79% making it’s management a true challenge. Clinical manifestations vary thus common symptoms include abdominal pain and digestive bleeding and may or may not include signs of hemodynamic instability. Until now there is no consensus regarding the management of FAE hence the pillars of treatment include: infection control, vascular reparation and enteric reconstruction. A multidisciplinary team is imperative.
We are presenting the case of a 76-year-old female with various comorbidities and a history of an aortic bifemoral bypass reconstruction due to aortic sclerosis disease; that presented with abdominal pain, upper digestive bleeding and hemodynamic instability. She was diagnosed with a FAE and sepsis. Taking into consideration international recommendations she was treated with a single procedure in two times. For the vascular correction: an extra-anatomical bypass; removal of previous prosthetic aortic implant and closure of the aortic stump. Due to the magnitude of the intestinal damage simple closure and intestinal derivation were discarded as options for enteric repair and a Whipple procedure was used as a last resource.
Downloads
References
Girotti M, Kibbe MR. Chapter 88. Aortoenteric fistula and visceral artery aneurysms. En: Yeo CJ, editor. Shackelford’s Surgery of the Alimentary Tract, 2 Volume Set (Eighth Edition) [Internet]. Philadelphia: Content Repository Only!; 2019 [citado 24 de abril de 2018]. p.1040-1055. Disponible en: http://www.sciencedirect.com/science/article/pii/B9780323402323000881
Canaud L, Ricco J-B, Marty-Ané C, Alric P. Trattamento chirurgico delle infezioni delle protesi aortiche. EMC - Tec Chir Vasc 2017;22(4):1-12.
Gülcü A, Gezer NS, Uğurlu ŞB, Göktay AY. An aortoenteric fistula arising after endovascular management of a mycotic abdominal aortic aneurysm complicated with a psoas abscess. Iran J Med Sci 2016;41(4):350-353.
Tang S-J, Patnana S, Wu R, Rivard A. Aortoenteric Fistula. Video J Encycl GI Endosc. 1 de abril de 2014;2(1):32-35.
Janko M, Ciocca RG, Hacker RI. Vertebral osteophyte as possible etiology of aortoenteric fistula. Ann Vasc Surg [Internet]. 5 de febrero de 2018 [citado 22 de abril de 2018]; Disponible en: http://www.sciencedirect.com/science/article/pii/S0890509618300888
Nehme F, Rowe K, Munguti C, Nassif I. A rare cause of primary aortoenteric fistula: Streptococcus parasanguinis aortitis [Internet]. Case Reports in Gastrointestinal Medicine. 2017 [citado 22 de abril de 2018]. Disponible en: https://www.hindawi.com/journals/crigm/2017/9087308/abs/
Liao E, Simons M, Tse LW, Roche-Nagle G. Toothpick-induced aortoenteric fistula presenting as sepsis. BMJ Case Rep. 13 de junio de 2017;2017:bcr-2016-218338.
Spanos K, Kouvelos G, Karathanos C, Matsagkas M, Giannoukas AD. Current status of endovascular treatment of aortoenteric fistula. Semin Vasc Surg 2017;30(2):80-84.
Han Y, Kwon T-W, Park SJ, Jeong M-J, Choi K, Ko G-Y, et al. The results of in situ prosthetic graft replacement for infected aortic disease. World J Surg 2018;1-7.
Zheng H, Troutman DA, Dougherty MJ, Calligaro KD. Repair of aortoenteric fistula secondary to graft placement for middle aortic syndrome. Ann Vasc Surg 2015;29(3):596.e7-596.e10.
Kahlberg A, Rinaldi E, Piffaretti G, Speziale F, Trimarchi S, Bonardelli S, et al. Results from the multicenter study on aortoenteric fistulization after stent grafting of the abdominal aorta (MAEFISTO). J Vasc Surg 2016;64(2):313-320.e1.
Karthaus EG, Post ICJH, Akkersdijk GJM. Spontaneous aortoenteric fistula involving the sigmoid: A case report and review of literature. Int J Surg Case Rep 2016;19:97-99.
Kasashima S, Kawashima A, Kasashima F, Endo M, Matsumoto Y, Kawakami K, et al. Immunoglobulin G4-related periaortitis complicated by aortic rupture and aortoduodenal fistula after endovascular AAA repair. J Endovasc Ther 2014;21(4):589-597.
Tripathi RK. Introduction: Management of infected aortic pathology. Semin Vasc Surg 2017;30(4):105.
Malik MU, Ucbilek E, Sherwal AS. Critical gastrointestinal bleed due to secondary aortoenteric fistula. J Community Hosp Intern Med Perspect [Internet]. 11 de diciembre de 2015 [citado 23 de julio de 2018];5(6). Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677592/
Ono S, Samejima Y, Watada S, Kakefuda T. Secondary aortoenteric erosion followed by recurrent lower extremity abscesses. Ann Vasc Surg 2017;42:302.e1-302.e5.
Schoell T, Manceau G, Chiche L, Gaudric J, Gibert H, Tresallet C, et al. Surgery for secondary aorto-enteric fistula or erosion (SAEFE) complicating aortic graft replacement: a retrospective analysis of 32 patients with particular focus on digestive management. World J Surg 2015;39(1):283-291.
Deijen CL, Smulders YM, Coveliers HME, Wisselink W, Rauwerda JA, Hoksbergen AWJ. The importance of early diagnosis and treatment of patients with aortoenteric fistulas presenting with herald bleeds. Ann Vasc Surg 2016;36:28-34.
Chick JFB, Castle JC, Cooper KJ, Srinivasa RN, Eliason JL, Osborne NH, et al. Aortoenteric fistulae temporization and treatment: lessons
learned from a multidisciplinary approach to 3 patients. Radiol Case Rep 2017;12(2):331-334.
Fang H, Rubio-Tapia A, Coelho-Prabhu N. Aortoenteric fistula: A worrisome endoscopic finding. Rev Gastroenterol México Engl Ed. 1 de abril de 2018;83(2):194-195.
Raman SP, Kamaya A, Federle M, Fishman EK. Aortoenteric fistulas: spectrum of CT findings. Abdom Imaging. 2013;38(2):367-375.
Expediente Clinico Nro. 77831401. Hospital Metropolitano, Quito-Ecuador; 2017.
Zaki M, Tawfick W, Alawy M, ElKassaby M, Hynes N, Sultan S. Secondary aortoduodenal fistula following endovascular repair of inflammatory abdominal aortic aneurysm due to Streptococcus anginosus infection: A case report and literature review. Int J Surg Case Rep 2014;5(10):710-713.
Yang DY, Wiebe E, Peerani F. Aortoenteric fistula: A rare cause of upper gastrointestinal bleed captured on endoscopy with exceptional clarity. Dig Liver Dis [Internet]. 9 de julio de 2018 [citado 22 de abril de 2018];0(0). Disponible en: https://www.dldjournalonline.com/article/S1590-8658(18)30810-7/fulltext
Capoccia L, Mestres G, Riambau V. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR). J Cardiovasc Surg (Torino) 2014;55(3):381-389.
Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Editor’s Choice - Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: A review and pooled data analysis. Eur J Vasc Endovasc Surg 2016;52(6):770-786.
Herdrich BJ, Fairman RM. How to manage infected aortic endografts. J Cardiovasc Surg (Torino) 2013;54(5):595-604.
Sharif MA, McDowell DA, Badger SA. Chlamydia pneumoniae antibodies and C-reactive protein levels in patients with abdominal aortic aneurysms. Scientific World Journal 2013;2013:212450.
Temporizing amplatzer closure of an aorto-enteric fistula associated with a blind aortic stump via a translumbar approach [Internet]. [citado 22 de abril de 2018]. Disponible en: http://vpjournal.net/article/view/2385
Moulakakis KG, Kakisis J, Dalainas I, Smyrniotis V, Liapis CD. Endovascular management of secondary aortoduodenal fistula: the importance of gut restoration. Int J Angiol Off Publ Int Coll Angiol Inc. 2015;24(1):55-58.
Keunen B, Houthoofd S, Daenens K, Hendriks J, Fourneau I. A case of primary aortoenteric fistula: Review of therapeutic challenges. Ann Vasc Surg 2016;33:230.e5-230.e13.
Idhrees AM, Jacob A, Velayudhan BV. An aorto--oesophageal fistula following endograft: sealing of fistulae with omentum and replacement of the aorta. Interact Cardiovasc Thorac Surg 2018;26(3):516-518.
Rodrigues dos Santos C, Casaca R, Mendes de Almeida JC, Mendes-Pedro L. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg 2014;28(3):756-762.
Chopra A, Cieciura L, Modrall JG, Valentine RJ, Chung J. Twenty-Year Experience With Aorto-Enteric Fistula Repair: Gastrointestinal Complications Predict Mortality. J Vasc Surg 2017;66(5):1625.
Michael W. Mulholland, Keith D. Lillemoe, Gerard M. Doherty, Ronald V. Maier, Diane M. Simeone, Gilbert R. Upchuch Jr. Greenfield’s Surgery Scientific Pinciples and Practice. 5th edition. Vol. Volume 1. Philadelphia: Lippincott Williams And Wilkins; 2011;pp.851.
Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. BJS 2014;101(1):e109-18.
Lukasiewicz, Molski. Secondary aorto-enteric fistula - still a devastating complication of major vascular surgery. Vasa 2011;40(2):139-145.
Rembacken B. Hemostatic procedures in the bleeding anastomosis. En: Endoscopic follow-up of digestive anastomosis [Internet]. Springer, Milano; 2014 [citado 24 de julio de 2018]. p. 131-6. Disponible en: https://link.springer.com/chapter/10.1007/978-88-470-5370-0_15
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Camila Bautista, Jorge Albán
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
