Related Subjects:
|Aortic Anatomy
|Acute Coronary Syndrome (ACS) General
|Aortic Dissection
|Acute Heart Failure and Pulmonary Oedema
|Aortic Regurgitation (Incompetence)
|Aortic Stenosis
|Aortic Sclerosis
|Transcatheter aortic valve implantation (TAVI)
⚠️ Always suspect an Aortoenteric Fistula (AEF) in any patient with
GI bleeding or recurrent infection after aortic repair or graft surgery.
💀 Mortality is extremely high (20–30%), and survival depends on rapid recognition and surgical intervention.
📌 About
- A pathological connection between the aorta and the GI tract.
- Duodenum is the most common site (≈80%).
- Other possible sites: stomach, oesophagus, jejunum.
- A potentially rapidly fatal cause of GI bleeding.
🧾 Aetiology
- Most often due to previous abdominal aortic aneurysm (AAA) repair (open or endovascular).
- May involve graft erosion, stent migration, or post-surgical infection.
- Inflammatory tissue reaction and recurrent sepsis predispose to fistula formation.
- Rarely, spontaneous/primary fistula from atherosclerotic aneurysm rupture into bowel.
📑 Classification
- Primary: spontaneous, due to untreated aneurysm eroding into bowel (rare).
- Secondary: after aortic surgery, graft, or stent placement (much more common).
🤒 Clinical Features
- ⚠️ Herald bleed – a small, self-limiting GI bleed, often followed hours–days later by catastrophic haemorrhage.
- Massive GI haemorrhage (haematemesis, melaena, or haematochezia).
- Abdominal/back pain and sepsis may precede bleeding.
- Signs of shock: pallor, hypotension, tachycardia, collapse.
🧪 Investigations
- Bloods: FBC, U&E, LFTs, clotting, group & save/crossmatch.
- CXR, ECG (pre-op baseline, exclude chest pathology).
- Upper GI endoscopy: may miss diagnosis (often obscured by clot).
- CT angiography: highly sensitive for detecting peri-graft inflammation, contrast extravasation, or direct fistula.
🏥 Management
- 🔺 Immediate ABC resuscitation (airway, oxygen, large-bore IV access, fluids, blood products via major haemorrhage protocol).
- Broad-spectrum IV antibiotics if sepsis suspected.
- ⚡ Urgent vascular surgery – definitive management is by emergent laparotomy and repair (options: graft excision, extra-anatomic bypass, or in some cases, endovascular stent as a bridge).
- ICU admission post-op for haemodynamic and sepsis management.
- Mortality directly correlates with delay to surgery.
📚 References
