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aortoenteric fistula; aortoduodenal fistula

Epidemiology: 1) uncommon 2) many patients have undergone aortic graft surgery 2 months to 8 years prior to presentation with an UGI bleed Pathology: 1) potentially lethal cause of upper gastrointestinal (UGI) bleeding 2) 90% are aortoduodenal fistulas Clinical manifestations: - the classic presentation is a 'herald' bleed hours to weeks prior to a massive UGI hemorrhage Special laboratory: - esophagogastroduodenoscopy (EGD) Radiology: - abdominal CT with contrast (first diagnostic test) [2] - CT angiography with delayed images (NEJM) [4] - angiography [2] Management: - surgery

Related

upper gastrointestinal hemorrhage

General

arterial fistula intestinal fistula

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 352
  2. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  3. Singh M, Koyfman A, Martinez JP. Abdominal Vascular Catastrophes. Emerg Med Clin North Am. 2016 May;34(2):327-39. Review. PMID: 27133247
  4. NEJM Knowledge+ Gastroenterology