Abstract

*Saman Anwar, Ayesha Shayan, Rida Zainab, Ramsha Fatima, Hina Naseer, Jawaid Iqbal

ABSTRACT

Aortoenteric fistula (AEF) is an abnormal connection between the aorta or its major arterial branches and part of the gastrointestinal tract. It is fairly uncommon, but a rather fatal condition. It has either a primary or secondary etiology, secondary being more common. We report the case of a 61 year old woman with a history of hypertension who presented in the ER with lower abdominal pain and vomiting for the past 10 days. She underwent CTA of thoracoabdominal aorta and was diagnosed as abdominal aortic aneurysm, for which she later underwent surgery. About 45 days later, she was brought to the ER again with hematemesis and melena. Her CTA of thoracoabdominal aorta again showed abdominal aortic aneurysm adherent with adjacent small bowel loops with surrounding multiple air specks and extravasation of contrast from aortic to duodenal lumen, likely representing aortoenteric fistula. Esophagogastroduodenoscopy was done to secure bleeding site however due to poor hemodynamic status of patient, procedure was abandoned and a second surgery was performed day after, where fistulous communication was intervened and jejunostomy was made. 1 week later, the patient died due to sudden myocardial infarction. Our report highlights a fatal manifestation of aortoenteric fistula, and reviews the associated literature.