title: Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment.
abstract: Primary aortoenteric fistula (PAEF) is a potentially fatal condition which poses a considerable diagnostic challenge because of its infrequency and the nonspecific presentation. We report the case of a 61-year old woman who presented to her general practitioner with nonspecific and intermittent rectal bleeding, hematemesis, and weight loss. Four days later, she presented to the emergency department with worsening symptoms. The investigations revealed a new small 3.8-cm abdominal aortic aneurysm on computed axial tomography (CT), however, no evidence of a fistula was observed either on CT scan or endoscopy. Two days later, she became unstable requiring an emergency laparotomy and was taken to the operation theater for an en bloc resection of a segment of the aorta and duodenum with exclusion of the duodenum with an inline reconstruction of the aorta using a Dacron graft for a PAEF. The published data were reviewed to address the issues of optimal diagnostic methods and management of PAEF.
authors.affiliation: Department of Vascular Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia. weranja@gmail.com
authors.forename: Weranja
authors.initials: W
authors.lastname: Ranasinghe
authors.forename: Jacky
authors.initials: J
authors.lastname: Loa
authors.forename: Nile
authors.initials: N
authors.lastname: Allaf
authors.forename: Kerry
authors.initials: K
authors.lastname: Lewis
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Sebastian
mesh_terms: D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D001027:Aortography / Q000379:methods; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D012007:Rectum; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D014656:Vascular Surgical Procedures; D015431:Weight Loss