Clinical Presentations of Secondary Aortoenteric Fistulae: Case Report and Literature Review

Abstract

Aortoenteric fistulae (AEF) are a rare and potentially life-threatening cause of upper gastrointestinal bleeding. Here, we present a case of bleeding from a secondary AEF with an unusual pattern. Our case was quite atypical in that our patient had multiple episodes of self-limiting overt bleeding over the course of two years, which is in stark contrast to the paradigm of “herald bleeding” followed by a second catastrophic bleed, which is often fatal in secondary AEFs. We also retrospectively analyzed the literature over the last decade (2002-2012), pulling case reports and reviews that identified patients with secondary AEFs, and the diagnostic methods utilized. We categorized these secondary AEFs by age, sex, time from initial surgery to diagnosis, presenting symptoms, location of fistula, intervention taken, and outcome. The objective was to find the similarities in these cases and thus propose a diagnostic workup, or guideline, for identifying this specific type of bleed in comparison to other gastroenteric bleeds. The conclusion remains similar to those of the authors that we reviewed: the initial diagnosis of secondary AEFs—and thus the ability to reduce their complications—remains a problem.