Aortoenteric fisulta

• Fistula formed between aorta and intestines
  • Can be primary or secondary (often due to AAA repair)
  • Can form fistula anytime within life of AAA graft repair
    • Higher risk with recent graft placement
• Involves the duodenum (ADF) in most cases[1]
• Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
• Mortality of 100% if left untreated

• Classic triad: abdominal pain, GI bleeding and pulsatile abdominal mass
  • Present in 23% of patients
• Low grade fever
• Abdominal pain
• Back pain
• History of AAA graft
• BRBPR or melena
  • Herald bleed - initial melena or hematochezia with few hemodynamic changes; then followed by severe bleed

If suspicion high, involve vascular surgery early

• CBC
• Chem 10
• Type and Cross
• PT/INR/PTT
• Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
• Aortic ultrasound and FAST exam to assess for AAA and Free Fluid
• CXR for pre-op, if patient stable
• ECG for pre-op
• CTA of abdomen/pelvis, highly sensitive, if patient stable
• Patient may need gastroduodenal endoscopy

• Fluid resuscitation
• Transfuse pRBCs as needed
• Surgical Intervention
  • Transfer if not available

• Admission