Journal List > Korean J Gastroenterol > v.61(4) > 1007078

Korean J Gastroenterol. 2013 Apr;61(4):230-233. Korean.
Published online April 24, 2013.  https://doi.org/10.4166/kjg.2013.61.4.230
Copyright © 2013 The Korean Society of Gastroenterology
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 and 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, Email: mhs1357@hanmail.net
Received May 25, 2012; Revised September 12, 2012; Accepted September 12, 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. Intra-arterial 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

Figures


Fig. 1
(A) Duodenoscopy showing no evidence of a bleeding focus. (B) Melena was detected by colonoscopy, suggesting bleeding in the upper intestinal tract.
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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).
Click for larger image


Fig. 3
Angiography showing contrast leakage into the bowel via the fistula tract.
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Fig. 4
Microcoils were inserted into sac-like dilatation of the fistula tract.
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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.
Click for larger image

Notes

Financial support: None.

Conflict of interest: None.

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