IS Case 344: Aortoenteric fistula
2009 URMC Imaging Sciences
Publication Date: 2009-11-09
An aortoenteric fistula can present clinically as limited or massive GI bleeding. Upper endoscopy and colonoscopy are often unremarkable, and the history of an aortic graft repair is the one clue to diagnosis.
Primary aortoenteric fistulae are rare. More commonly they are secondary, occurring after aortic aneurysm repair. Less than 2% of repairs develop this complication. Other conditions leading to a secondary fistula formation include an aortic aneurysm, aortitis, radiation therapy, malignancy, and peptic ulcer disease. Because of its close proximity to the aorta, the third portion of the duodenum is often involved, although any section of the GI tract can potentially fistulize.
CT is the preferred radiologic examination. Water as an oral contrast agent can help aid for intestinal blood or extravasated contrast. A tagged red blood cell scan, aortography, upper GI, and ultrasound can also be used.
- Low RN, Wall SD, Jeffrey RB Jr, Sollitto RA, Reilly LM, Tierney LM Jr. Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology. 1990 Apr;175(1):157-62. PMID: 2315475
- Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002 Jul;224(1):9-23. PMID: 12091657