Case Report; Primary Aortoenteric Fistula Due to Plum Kernel

Year 2022, , 37 - 39, 23.06.2022

Hilal Hocagil , Abdullah Cüneyt Hocagil

https://doi.org/10.33706/jemcr.1009451

Abstract

Introduction: Aortoenteric fistulas are defined as an abnormal connection between the aorta and any portion of the gastrointestinal tract. It can occur after aortic repair surgery or spontaneously (primary). The common clinical features of primary aortoenteric fistula are upper gastrointestinal bleeding, abdominal pain, and pulsatile abdominal mass. The reasons are inflammatory destruction of an aortic aneurysm, infection, tumors and ingestion of foreign bodies.
We represent a case of a primary aortoenteric fistula due to plum kernel which is rarely seen.
Case Report: A 76-year-old man admitted to emergency department with abdominal pain. On computed tomography angiography, there was hypodense restricted lesion with widespread air image which was located around the abdominal aorta. It was determined that abdominal aorta is surrounded by organised hematoma. A plum kernel, was detected in the operating room, was the reason for the aortoenteric fistula. Graft was placed in the abdominal aorta. He died in the first day after surgery.
Conclusions: Primary aortoenteric fistulas should be considered in differential diagnosis of abdominal pain, upper gastrointestinal bleeding and shock in patient with aortic aneurysm. Kernels of any fruit considered to be harmless just as plum kernel and should be noted that may cause aortoenteric fistula.

Keywords

Primary aortoenteric fistula, gastrointestinal bleeding, abdominal pain, plum kernel.

Supporting Institution

no

Project Number

-

Thanks

We would like to thank Hasan Can Taskin and Elif Coskun for his assistance

References

• 1. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg 2005; 92:143-152 doi: 10.1002/bjs.4928.
• 2. Xiromeritis K, Dalainas I, Stamatakos M, Filis K. Aortoenteric fistulae: present-day management. Int Surg. 2011 Jul-Sep;96(3):266-73. DOI: 10.9738/0020-8868-96.3.266
• 3. Saers SJ, Scheltinga MR, Salemans JM, Kitslaar PJ. Gastroenterological aspects of primary aorto-enteric fistulae. Act Chir Belg 2009; 109: 741-745 doi: 10.1080/00015458.2009.11680527.
• 4. Connolly JE, Kwaan JH, McCart PM, Brownell DA, Levine EF. Aortoenteric fistula. Ann Surg. 1981 Oct;194(4):402-12. doi: 10.1097/00000658-198110000-00004.
• 5. Chung J. Management of Aortoenteric Fistula. Advances in Surgery 2018;52: 155-177 doi: 10.1016/j.yasu.2018.03.007. Epub 2018 Apr 26.
• 6. Başer M, Arslantürk H, Kisli E, Arslan M, Oztürk T, Uygan I, et al. Primary aortoduodenal fistula due to a swallowed sewing needle: a rare cause of gastrointestinal bleeding.TJTES 2007;13:154-157 https://pubmed.ncbi.nlm.nih.gov/17682960/
• 7. Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy Clinical Guideline. Endoscopy 2016; 48:1-8 doi: 10.1055/s-0042-100456
• 8. Karthaus EG, Post IC, Akkersdijk GJ. Spontaneous aortoenteric fistula involving the sigmoid: A case report and review of literature. Int J Surg Case Rep 2016; 19: 97–99. doi: 10.1016/j.ijscr.2015.12.015
• 9. Rossi UG, Cariati M. Aortoenteric fistula. J Cardiovasc Comput Tomogr. 2015; 9:461-2. doi: 10.1016/j.jcct.2015.03.009.
• 10. Armstrong PA, Back MR, Wilson JS, Shames ML, Johnson BL, Bandyk DF. Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg 2005; 42:660-6 doi: 10.1016/j.jvs.2005.06.020.