1566 A Rare Case of Aorto-Duodenal Fistula Associated with Bacterial Meningitis

Aorto-enteric fistula (AEF) is an extremely rare complication of aortic disease with potentially fatal outcome. AEF is defined as a fistulous connection between aorta and bowel and can be classified into primary (involving native aorta) or secondary (occurring after aortic surgery). Primary AEF is by far the less common of the two and may be associated with malignancy, radiotherapy or infection. We present a case of a 75-year-old male presenting with collapse and haemetemesis. CT imaging revealed a fistula between native aorta and duodenum. Emergency surgery was carried out but ultimately the patient did not survive. The underlying cause remains uncertain. Notably, the patient had a recent history of bacterial meningitis 6 months prior to presentation and, despite negative cultures, infection of the aortic wall was strongly suspected.

Case Report: Duodenoscopy diagnosis of a secondary aorto-duodenal fistula: A case report and review of literature.

Secondary aorto-enteric fistula (SAEF) is a rare life-threatening complication occurring in patients with previous infrarenal aortic prosthetic reconstruction. The main symptom is a gastrointestinal bleeding. Its diagnosis is challenging due to the lack of a specific clinical signs. The failure of early diagnosis and treatment of this entity can lead to fatal issue. Actually, the abdominal computed tomography angiogram represents the principal exploration to confirm the diagnosis, but it is associated with a moderate specificity and sensibility. Duodenoscopy can highlight the communication between the duodenum and the prosthetic graft, but it is often inconclusive. We report in this manuscript a case of secondary aorto-enteric fistula revealed by occult gastrointestinal bleeding in an elderly patient who is admitted for severe anemia. The SAEF diagnosis was suspected by the computed tomography scan and confirmed by the duodenoscopy showing an exceptional image of Dacron graft protruding in the third duodenum lumen. Unfortunately, the patient died from cataclysmic shock before intervention. We overview also the rare previous published case reports concerning the endoscopic images of secondary aortoenteric fistula and we contrast our findings with those reported in the literature.

A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.

Traumatic Arterio-Enteric Fistula—A Report of 2 Cases With Review of Literature

Background: Traumatic arterio-enteric fistula is predominantly seen after penetrating trauma with only 21 reported cases documented in the past 25 years. They may present in an acute or delayed manner with upper or lower gastrointestinal bleed. A detailed clinical examination with requisite imaging can help in detecting such injuries. Case Description: Case 1: A 20-year-old gentleman, presented with penetrating stab injury to the gluteal region with bleeding per rectum. Imaging revealed evidence of injury to the inferior rectal artery which was found to be communicating with the extraperitoneal portion of the rectum. He was managed with a combination of endovascular and open surgery with a successful outcome. Case 2: A 29-year-old gentleman, presented in a delayed manner 2 weeks after a gunshot wound to the gluteal region, which was managed operatively in another hospital. He developed a massive lower gastrointestinal bleed 2 weeks after presentation. Imaging revealed evidence of a pseudoaneurysm of the inferior gluteal artery which had a fistulous communication with the gastrointestinal tract leading to bleeding. It was managed by endovascular techniques successfully. Conclusion: Arterio-enteric fistulas following trauma are rare phenomena and they need a high index of suspicion for diagnosis. Once diagnosed, they can be managed based on their location and patient physiology by interventional techniques, surgery, or a combination of the two.