Common Causes Rare Causes Under 40 years old Over 40 years old Henoch--Schoenlein purpura Inflammatory bowel Angioectasia Amyloidosis disease Dieulafoy lesions Dieulafoy lesions Osler--Weber--Rendu syndrome Neoplasia Neoplasia Hemobilia Meckel diverticulum NSAID ulcers
Aortoenteric fistula Polyposis syndromes Small bowel varices and (e.g.
Aortoenteric fistula (AEF) is one of the rare causes of GI bleeding that can be fatal if not diagnosed and treated promptly.
It is thought to be the preliminary step of secondary
aortoenteric fistula and does not involve anastomosis between aorta and graft.
It is rare for air to be seen inside a thrombus around the aortic lumen, and this should suggest the presence of an
aortoenteric fistula. The best means for detecting such a fistula is oral and intravenous contrast CT (2).
Grabs AJ, Irvine CD, Lusby RJ (2000) Stent graft treatment for bleeding from a presumed
aortoenteric fistula. Journal of Endovascular Therapy 7(3): 236-239.
Primary
aortoenteric fistula: report of eight new cases and review of the literature.
There are two forms of AEF when surgical procedures are performed in the abdominal aorta (2): primary
aortoenteric fistula (PAEF) or secondary to Endovascular Aneurysm Repair (EVAR).
Unstable patients might benefit from stent graft (Level 4, Recommendation C); stable patients with
aortoenteric fistula should receive staged procedure with extra-anatomic bypass first (Level 2c, Recommendation B); and finally stable patients without
aortoenteric fistula (patients that do not have direct communication between proximal anastomosis and bowel but infected paraanastomotic sinus) should receive in situ revascularization using autogenous superficial femoral vein or aortoiliac allograft (Level 2c, Recommendation C) (2).
Primary
aortoenteric fistula (PAEF) is a direct communication between the aorta and the intestinal lumen without prior reconstructive procedures on the abdominal aorta.
One month after discharge, a screening colonoscopy did not reveal any
aortoenteric fistula or colorectal malignancy.
Q fever has reportedly been associated with abdominal aortic aneurysm,
aortoenteric fistula, lower limb fistula, vascular graft infection, vertebral body erosions, CNS infection, fever of unknown origin, and possible pancreatitis [3,4,7-10].
Since the first description of primary ADF was published by Astley Cooper in 1839, less than 200 primary
aortoenteric fistula (AEF) cases have been reported in the English-language literature; 73% of primary AEF were from atherosclerotic aneurysms, 26% were from traumatic or mycotic aneurysms, and the remaining 1% were caused by radiation, metastases, pancreatic carcinoma, ulcers, gallstones, diverticulitis, appendicitis, and cystic medial necrosis [1].