A Case of Angiographic Embolization of Aortoenteric Fistula Caused by Endovascular Stent Grafting for an Abdominal Aortic Aneurysm

Kwang Hun Ko; Seul Young Kim; Il Soon Jung; Kyu Seop Kim; Hee Seok Moon; Jae Kyu Seong; Hyun Yong Jeong

doi:10.4166/kjg.2013.61.4.230

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Ko, Kim, Jung, Kim, Moon, Seong, and Jeong: A Case of Angiographic Embolization of Aortoenteric Fistula Caused by Endovascular Stent Grafting for an Abdominal Aortic Aneurysm

Case Report

Korean J Gastroenterol 2013;61(4):230-233.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.4.230

A Case of Angiographic Embolization of Aortoenteric Fistula Caused by Endovascular Stent Grafting for an Abdominal Aortic Aneurysm

Kwang Hun Ko, Seul Young Kim, Il Soon Jung, Kyu Seop Kim, Hee Seok Moon, Jae Kyu Seong, Hyun Yong Jeong

Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence to: Hee Seok Moon, Department of Internal Medicine, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7143, Fax: +82-42-257-5753, E-mail: mhs1357@hanmail.net

Received 25 May 201212 September 2012 Accepted 12 September 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intraarterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.

Keywords: Aortoenteric fistula, Abdominal aortic aneurysm, Endovascular stent

References

1. Flye MW, Thompson WM. Aortic graft-enteric and para-prosthetic-enteric fistulas. Am J Surg. 1983; 146:183–187.

2. Voorhoeve R, Moll FL, de Letter JA, Bast TJ, Wester JP, Slee PH. Primary aortoenteric fistula: report of eight new cases and review of the literature. Ann Vasc Surg. 1996; 10:40–48.

3. Reynolds JV, Galloway JM. Primary aortoduodenal fistula: a case report and review of the literature. Ir J Med Sci. 1991; 160:381–384.

4. Brock RC. Aortic homografting; a report of six successful cases. Guys Hosp Rep. 1953; 102:204–228.

5. Birch L, Cardwell ES, Claytor H, Zimmerman SL. Suture-line rupture of a nylon aortic bifurcation graft into the small bowel. AMA Arch Surg. 1956; 73:947–950.

6. Yu SB, Park SC, Moon IS, Koh YB. Primary aortoduodenal fistula in salmonella mycotic aortic aneurysm: a case report. J Korean Soc Vasc Surg. 2003; 19:79–82.

7. Kalman DR, Barnard GF, Massimi GJ, Swanson RS. Primary aortoduodenal fistula after radiotherapy. Am J Gastroenterol. 1995; 90:1148–1150.

8. Broadbent NR, Taylor DE. Gallstone erosion of the aorta. Aust N Z J Surg. 1975; 45:207–208.

9. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005; 92:143–152.

10. Berry SM, Fischer JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am. 1996; 76:1009–1018.

11. Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery. 1984; 96:492–497.

12. Elliott JP Jr, Smith RF, Szilagyi DE. Proceedings: Aortoenteric and paraprosthetic-enteric fistulas. Problems of diagnosis and management. Arch Surg. 1974; 108:479–490.

13. Korkut AK, Arpinar E, Yasar T, Guney D. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm. J Cardiovasc Surg (Torino). 2000; 41:113–115.

14. Mylona S, Ntai S, Pomoni M, Kokkinaki A, Lepida N, Thanos L. Aortoenteric fistula: CT findings. Abdom Imaging. 2007; 32:393–397.

15. Brand EJ, Sivak MV Jr, Sullivan BH Jr. Aortoduodenal fistula: endoscopic diagnosis. Dig Dis Sci. 1979; 24:940–944.

16. Kim JY, Kim YW, Kim CJ, Lim HI, Kim DI, Huh S. Successful surgical treatment of aortoenteric fisula. J Korean Med Sci. 2007; 22:846–850.

17. Loftus IM, Thompson MM, Fishwick G, et al. Technique for rapid control of bleeding from an aortoenteric fistula. Br J Surg. 1997; 84:1114.

18. Karkos CD, Bruce IA, Lambert ME. Use of the intra-aortic balloon pump to arrest gastrointestinal bleeding. Ann Emerg Med. 2001; 38:328–331.

19. Finch L, Heathcock RB, Quigley T, et al. Emergent treatment of a primary aortoenteric fistula with N-butyl 2-cyanoacrylate and endovascular stent. J Vasc Interv Radiol. 2002; 13:841–843.

20. Cekirge S, Oguzkurt L, Saatci I, et al. Embolization of a high-out-put post-nephrectomy aortocaval fistula with Gianturco coils and cyanoacrylate. Cardiovasc Intervent Radiol. 1996; 19:56–58.

Fig. 1.

(A) Duodenoscopy showing no evidence of a bleeding focus. (B) Melena was detected by colonoscopy, suggesting bleeding in the upper intestinal tract.

Fig. 2.

(A) Computed tomography scan showing a bleeding point in the fourth portion of the duodenum, suggesting an aortoenteric fistula (arrow). (B) Computed tomography scan showing a small foci of air around the frame of the device (arrow head).

Fig. 3.

Angiography showing contrast leakage into the bowel via the fistula tract.

Fig. 4.

Microcoils were inserted into sac-like dilatation of the fistula tract.

Fig. 5.

Embolization was performed by injecting a mixture of glue and lipiodol. After the procedure there was no longer any leakage of contrast through the fistula tract.

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