Majallah-i Dānishgāh-i ̒Ulūm-i Pizishkī-i Bābul (Mar 2024)
A Rare Case of Acute Gastrointestinal Bleeding Following an Aortoenteric Fistula
Abstract
Background and Objective: Aortoenteric fistula (AEF) is a rare but life-threatening condition. Secondary AEF in patients with a history of aortic surgery with symptoms of sudden gastrointestinal bleeding may occur even without evidence in endoscopy and colonoscopy, and delay in diagnosis and lack of timely surgery may lead to the death of the patient, and it is important to consider it. This study introduces a 60-year-old man with a history of aortic surgery who referred to the Golestan Hospital in Ahvaz with a complaint of acute gastrointestinal bleeding and underwent surgery with the diagnosis of secondary AEF. Case Report: The patient is a 60-year-old man who had a history of Aortobifemoral Bypass surgery three years ago, and was hospitalized in the emergency room due to gastrointestinal bleeding (melena). The patient's heart rate was 110 beats per minute, the patient's systolic blood pressure was 90 mm Hg and diastolic blood pressure was 60 mm Hg (positive tilt test) and the patient's hemoglobin (HB) was 6 g/dl. The patient underwent fluid resuscitation by the gastroenterology service, received pantoprazole, blood and antibiotics, endoscopy and colonoscopy, but no pathological findings were found. A surgical consultation was requested for him, and the patient underwent emergency CT angiography of the abdominal vessels. Due to the prolonged bleeding, unstable hemodynamics and drop in hemoglobin, it was decided to operate the patient with the suspicion of AEF. During the operation, the aorta (in the renal part) was fistulated to the intestines (jejunum, 30 cm from Treitz ligament) through a 5 mm long tract, which was repaired. The day after the operation, the patient was conscious and had stable vital signs, and was discharged the following week with a good general condition. The patient was followed up monthly for one week, three weeks, and then up to six months, which showed normal conditions. Conclusion: Based on the results of this study, AEF should be considered as a rare but fatal diagnosis in a patient with a history of aortic surgery and lower gastrointestinal bleeding and should undergo emergency surgery.
