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Article: Diagnosis and management of primary aortoenteric fistulas-experience learned from eighteen patients

TitleDiagnosis and management of primary aortoenteric fistulas-experience learned from eighteen patients
Authors
Issue Date2008
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surg
Citation
Surgery, 2008, v. 143 n. 1, p. 43-50 How to Cite?
AbstractObjective: Misdiagnosis of primary aortoenteric fistula (PAEF) frequently occurs in clinical practice owing to the rarity of this condition. Herein we present the experience of diagnosis and management for PAEF. Methods: Eighteen patients with PAEF at 2 medical centers in China were reviewed. The clinical data, diagnostic procedures, treatment options, and patient outcomes were evaluated. Results: The fistulas were located at esophagus (5), duodenum (8), jejunum (3), ileum (1), and transverse colon (1). The etiologies include atherosclerotic aneurysms and foreign body. Typical abdominal triad (pain, upper GI bleeding, and abdominal pulsating mass) was found in 27.8% of patients, and Chiari's triad (mid-thoracic pain, sentinel hemorrhage, and massive bleeding after a symptom-free interval) was present in 3 of 5 cases with thoracic aortoesophageal fistulas. All patients had an average of 3.6 (1-9) episodes of gastrointestinal bleeding. The interval between the first sentinel hemorrhage and ultimate exsanguination ranged from 5 hours to 5 months (median, 4 days). Six patients (33.3%) were diagnosed or suggested by diagnostic tools including endoscopy, computerized tomography, and arteriography. Others were diagnosed by surgical exploration (7) and autopsy (5). One to 5 rounds (mean 1.8) of misdiagnosis occurred in 15 patients. Six patients recovered from surgery and remained well during a 36-month follow-up. The surgical options used included in situ replacement with vascular graft (3), aneurysmorraphy and closure of fistula (1), and endovascular stenting (2). Conclusions: A high index of suspicion is necessary for correct diagnosis and prompt management of PAEF, especially in patients with aortoiliac aneurysms presenting with gastrointestinal bleeding. In situ graft replacement and endovascular stent-graft may be the preferred therapeutic options. © 2008 Mosby, Inc. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/77753
ISSN
2015 Impact Factor: 3.309
2015 SCImago Journal Rankings: 1.620
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSong, Yen_HK
dc.contributor.authorLiu, Qen_HK
dc.contributor.authorShen, Hen_HK
dc.contributor.authorJia, Xen_HK
dc.contributor.authorZhang, Hen_HK
dc.contributor.authorQiao, Len_HK
dc.date.accessioned2010-09-06T07:35:21Z-
dc.date.available2010-09-06T07:35:21Z-
dc.date.issued2008en_HK
dc.identifier.citationSurgery, 2008, v. 143 n. 1, p. 43-50en_HK
dc.identifier.issn0039-6060en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77753-
dc.description.abstractObjective: Misdiagnosis of primary aortoenteric fistula (PAEF) frequently occurs in clinical practice owing to the rarity of this condition. Herein we present the experience of diagnosis and management for PAEF. Methods: Eighteen patients with PAEF at 2 medical centers in China were reviewed. The clinical data, diagnostic procedures, treatment options, and patient outcomes were evaluated. Results: The fistulas were located at esophagus (5), duodenum (8), jejunum (3), ileum (1), and transverse colon (1). The etiologies include atherosclerotic aneurysms and foreign body. Typical abdominal triad (pain, upper GI bleeding, and abdominal pulsating mass) was found in 27.8% of patients, and Chiari's triad (mid-thoracic pain, sentinel hemorrhage, and massive bleeding after a symptom-free interval) was present in 3 of 5 cases with thoracic aortoesophageal fistulas. All patients had an average of 3.6 (1-9) episodes of gastrointestinal bleeding. The interval between the first sentinel hemorrhage and ultimate exsanguination ranged from 5 hours to 5 months (median, 4 days). Six patients (33.3%) were diagnosed or suggested by diagnostic tools including endoscopy, computerized tomography, and arteriography. Others were diagnosed by surgical exploration (7) and autopsy (5). One to 5 rounds (mean 1.8) of misdiagnosis occurred in 15 patients. Six patients recovered from surgery and remained well during a 36-month follow-up. The surgical options used included in situ replacement with vascular graft (3), aneurysmorraphy and closure of fistula (1), and endovascular stenting (2). Conclusions: A high index of suspicion is necessary for correct diagnosis and prompt management of PAEF, especially in patients with aortoiliac aneurysms presenting with gastrointestinal bleeding. In situ graft replacement and endovascular stent-graft may be the preferred therapeutic options. © 2008 Mosby, Inc. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/surgen_HK
dc.relation.ispartofSurgeryen_HK
dc.titleDiagnosis and management of primary aortoenteric fistulas-experience learned from eighteen patientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0263-9319&volume=143&spage=43&epage=50&date=2008&atitle=Diagnosis+and+management+of+primary+aortoenteric+fistulas--experience+learned+from+eighteen+patientsen_HK
dc.identifier.emailQiao, L: lq8688@hotmail.comen_HK
dc.identifier.authorityQiao, L=rp00513en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.surg.2007.06.036en_HK
dc.identifier.pmid18154932-
dc.identifier.scopuseid_2-s2.0-37249050812en_HK
dc.identifier.hkuros141382en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-37249050812&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume143en_HK
dc.identifier.issue1en_HK
dc.identifier.spage43en_HK
dc.identifier.epage50en_HK
dc.identifier.isiWOS:000251973600006-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSong, Y=55494037600en_HK
dc.identifier.scopusauthoridLiu, Q=8590747200en_HK
dc.identifier.scopusauthoridShen, H=44661883600en_HK
dc.identifier.scopusauthoridJia, X=35484009800en_HK
dc.identifier.scopusauthoridZhang, H=23092595300en_HK
dc.identifier.scopusauthoridQiao, L=7202151719en_HK

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