Primary aortoenteric fistula related to septic aortitis
Keywords:
Septic aortitis, Primary aortoenteric fistula, Aneurysm, PseudoaneurysmAbstract
CONTEXT: Primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. A few patients have been described with other etiologies such as pseudoaneurysm originating from septic aortitis caused by Salmonella. OBJECTIVE: To present a rare clinical case of pseudoaneurysm caused by septic aortitis that evolved into an aortoenteric fistula. CASE REPORT: A 65-year-old woman was admitted with Salmonella bacteremia that evolved to septic aortitis. An aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. In the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. The aorta was sutured and an axillofemoral bypass was carried out. In the intensive care unit, the patient had a cardiac arrest that evolved to death.
Downloads
References
Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery 1984;96:492-7.
Perler BA, Ernst CB. Infected aneurysms. in: Veith FJ, Hobson RW, Williams RA, Wilson SE, editors. Vascular surgery: princi- ples and practice. New York: McGraw-Hill; 1994:589-608.
Voorhoeve R, Moll FL, Letter JAM, et al. Primary aortoenteric fistula: report of eight new cases and review of the literature. Ann Vasc Surg 1996;10:40-8.
Calligaro KD, Bergen WS, Savarese RP, et al. Primary aortoduodenal fistulae due to septic aortitis. J Cardiovasc Surg 1992;33:192-8.
Wheeler WE, Hanks J, Raman VK. Primary aortoenteric fistulas. Am Surg 1992;58:53-4.
McIntyre KE, Malone JM, Richards E, et al. Mycotic aortic pseudoaneurysm with aortoenteric fistula caused by Arizona hinshawii. Surgery 1982;91:173-7.
Goldbaum TS, Lindsay J Jr, Levy C, et al. Tuberculous aortitis presenting with an aortoduodenal fistula: a case report. Angiol- ogy 1986;37:519-23.
Morrow C, Safi H, Beall AC. Primary aortoduodenal fistula caused by Salmonella aortitis. J Vasc Surg 1987;6:415-8.
Oz MC, Brener BJ, Buda JA, et al. A ten-year experience with bacterial aortitis. J Vasc Surg 1989;10:439-49.
Voorhoeve R, Moll FL, Bast TJ. The primary aortoenteric fistula in the Netherlands: the unpublished cases. Eur J Vasc Endovasc Surg 1996;11:429-31.
Reckless JPD, McColl I, Taylor GW. Aortoenteric fistulae: an uncommon complication of abdominal aortic aneurysms. Br J Surg 1972;59:458-60.
Brenowitz JB, Williams CD. Successful repair of primary aortoduodenal fistula. Am Surg 1976;42:265-7.
Reiner MA, Brau AS, Schanzer H. Primary aortoduodenal fis- tula: case presentation and review of literature. Am J Gastroenterol. 1978;70:292-7.
Daugherty M, Shearer GR, Ernst CB. Primary aortoduodenal fistula: extra-anatomic vascular reconstruction not required for successful management. Surgery 1979;86:399-401.
Dossa CD, Pipinos I, Shepard AD, et al. Primary aortoenteric fistula. Ann Vasc Surg 1994;8:113-20.
Frizelle FA, Hung NA, Heslop JH, et al. Obscure gastrointestinal bleeding: idiopathic aortoduodenal fistula. J R Coll Surg Edinb 1991;36:331-3.
Goenka MK, Mehta SK, Kochhar R, et al. Primary aortoduodenal fistula in a 23-year-old man without an associated aortic aneurysm. Eur J Surg 1993;159:371-2.
Jaroch MT, Diehl JT, Zippert AM. Primary aortoduodenal fis- tula without abdominal aortic aneurysm. Cleve Clin Q 1985;52:579-81.
Stefles BC, O’Leary JP. Primary aortoduodenal fistula: a case report and review of the literature. Am Surg 1980;46:121-9.
Castilho Jr OT, Santos JS, Peres LC, et al. Fístula aortentérica primária. Rev Cir Vasc Angiol 1995;11:73-6.
Yegar RA, Taylor LM Jr, Moneta GL, Edwards JM, et al. Im- proved results with conventional management of infrarenal aor- tic infection. J Vasc Surgery 1999;30:76-83.
Svensson LG, Crawford ES. Aortic infections. In: Svensson LG, Crawford ES, editors. Cardiovascular and vascular disease of the aorta. Philadelphia: WB Saunders; 1997:126-52.
Walker WE, Cooley DA, Duncan JM, Hallman GL, Ott DA, Reul GJ. The management of aortoduodenal fistula by in situ replacement of the infected abdominal aortic graft. Ann Surg 1987;205:727-32.
Chan FY, Crawford ES, Coselli JS, et al. In situ prosthetic graft replacement for mycotic aneurysm of the aorta. Ann Thorac Surg 1989;47:193-203.
Torsello G, Sandman W, Geehrt A, et al. In situ replacement of infected vascular prosthesis with rifampin-soaked vascular grafts: early results. J Vasc Surg 1993;17:768-73.
Kieffer E, Bahnini A, Koskas F, Ruotolo C, Le Blevec D, Plissonnier D. In situ allograft replacement of infected infrarenal aortic prosthetic grafts: results in forty-three patients. J Vasc Surg 1993;17:349-56.
Claget GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/ femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg 1997;25:255-70.