Published 2021-12-28
Keywords
- aorto-digestive fistula,
- aortic replacement,
- gastrointestinal bleeding
How to Cite
Copyright (c) 2021 Belov D.V., Garbuzenko D.V., Andrievskikh S.I., Anufrieva S.S.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Aorto-digestive fistulas are a rare but extremely dangerous cause of massive gastrointestinal bleeding with a high risk of death. The aim of the review was to examine the modern principles of aorto-digestive fistula diagnosis and optimal treatment modalities.
Scientific publications and their reference lists were searched on PubMed database, Google Scholar and Russian Science Citation Index. Articles relevant to the topic, published over the past 25 years (1996-2021), were included and they were searched and categorised using the following key words: ‘gastrointestinal bleeding’, ‘aorto-digestive fistulas’, ‘diagnosis’ and ‘treatment’. Inclusion criteria were limited to gastrointestinal bleeding associated with aorto-digestive fistulas.
Patients with aortic aneurysms or those who have undergone prosthetics should have increased alertness regarding the formation of aorto-digestive fistulas. With a presence of gastrointestinal bleeding and exclusion of other sources based on multispiral computed tomography data with intravenous bolus contrast enhancement, this will allow for quick verification of the diagnosis and also enable timely medical measures to be taken. In an emergency situation, to achieve rapid hemostasis in unstable patients, endovascular aortic replacement is most justified. Open reconstruction of the aorta in situ with simultaneous elimination of the hollow organ defect and sanitation of fistula-associated foci of infection should be considered as a radical intervention for aorto-digestive fistulas.
Received 19 May 2021. Revised 7 July 2021. Accepted 9 July 2021.
Funding: The study did not have sponsorship.
Conflict of interest: Authors declare no conflict of interest.
Contribution of the authors: The authors contributed equally to this article.
References
- Inoue K., Fukunaga R., Matsubara Y., Aoyagi Y., Matsuda D., Kyuragi R., Morisaki K., Matsumoto T., Oki E., Maehara Y. Primary aortoduodenal fistula with a history of distal gastrectomy. Acute Med Surg. 2016;4(1):105-108. PMID: 29123844. PMCID: PMC5667283. https://doi.org/10.1002/ams2.224
- Dubrueil O. Observations sur la perforation de l'esophage et de l'aorte thoracique par une portion d'os avale: avec de reflexions. J Univ Sci Med. 1818;9:357-363.
- Chiesa R., Melissano G., Marone E.M., Kahlberg A., Marrocco-Trischitta M.M., Tshomba Y. Endovascular treatment of aortoesophageal and aortobronchial fistulae. J Vasc Surg. 2010;51(5):1195-1202. PMID: 20304579. https://doi.org/10.1016/j.jvs.2009.10.130
- Ong J., Swift C., Al-Naeeb Y. Aortogastric fistula: A rare glimpse of catastrophe. Clin Gastroenterol Hepatol. 2020;18(7):e72. PMID: 30928456. https://doi.org/10.1016/j.cgh.2019.03.033
- Chong V.H., Telisinghe P.U., Chong C.F. Tuberculous aorto-duodenal fistula: a rare cause of upper gastrointestinal bleeding. Singapore Med J. 2010;51(5):e85-e88. PMID: 20593135.
- Ramsay A.C., Ramsay M.P., Meekins P.E. Aortoenteric fistula in a 25-year-old man. J Emerg Med. 2013;45(4):533-536. PMID: 23777774. https://doi.org/10.1016/j.jemermed.2013.04.019
- Ishimine T., Tengan T., Yasumoto H., Nakasu A., Mototake H., Miura Y., Kawasaki K., Kato T. Primary aortoduodenal fistula: A case report and review of literature. Int J Surg Case Rep. 2018;50:80-83. PMID: 30086478; PMCID: PMC6085234. https://doi.org/10.1016/j.ijscr.2018.07.019
- Reich J., Li R., Hartigan A. Massive bleeding from an odd location. Gastroenterology. 2016;150(7):e11-e12. PMID: 27143593. https://doi.org/10.1053/j.gastro.2016.01.041
- Tsuneki T., Yuasa Y., Fukuta M., Maki H., Matsuo Y., Mori O., Eto Sh., Fujiwara S., Tomibayashi A., Otani T. Secondary aorto-duodenal fistula successfully treated with a novel surgical method: A case report. Int J Surg Case Rep. 2020;72:17-21. PMID: 32506022; PMCID: PMC7276383. https://doi.org/10.1016/j.ijscr.2020.05.041
- Абдулгасанов Р.А., Гасымов Э.Г. Аортокишечные фистулы: причины, диагностика, лечение, профилактика. Анналы хирургии. 2017;22(3):137-142. [Abdulgasanov R.A., Gasymov E.G. Aortoenteric fistula: causes, diagnosis, treatment, prevention. Annaly Khirurgii = Russian Annals of Surgery. 2017;22(3):137-142. (In Russ.)] https://doi.org/10.18821/1560-9502-2017-22-3-137-142
- Makimoto Sh., Takami T., Shintani H., Kataoka N., Yamaguchi T., Tomita M., Shono Y., Kuroyanagi S. Cases of two patients with aortoduodenal fistula who underwent emergency operation. Int J Surg Case Rep. 2020;69:87-91. PMID: 32305028; PMCID: PMC7163285. https://doi.org/10.1016/j.ijscr.2020.03.036
- Nachmias B., Bloom A.I., Gural A. Diagnostic and management difficulty of bleeding aorto-duodenal fistula associated with Hodgkin's lymphoma. Diagnostics (Basel). 2021;11(3):389. PMID: 33668895; PMCID: PMC7996524. https://doi.org/10.3390/diagnostics11030389
- Shen J.-Y., Zhang H.-W., Fan K.-J., Liao H., Zhang E.-Y., Hu J. Aortoesophageal fistula and arch pseudoaneurysm after removing of a swallowed chicken bone: a case report of one-stage hybrid treatment. BMC Surg. 2018;18(1):3. PMID: 29325526; PMCID: PMC5765606. https://doi.org/10.1186/s12893-018-0335-1
- Khalaf Ch., Houlind K.C. Case report: Primary aortosigmoid fistula – A rare cause of lower gastrointestinal bleeding. Int J Surg Case Rep. 2017;40:20-22. PMID: 28918295; PMCID: PMC5602515. https://doi.org/10.1016/j.ijscr.2017.08.063
- Dimech A.P., Sammut M., Cortis K., Petrovic N. Unusual site for primary arterio-enteric fistula resulting in massive upper gastrointestinal bleeding – A case report on presentation and management. Int J Surg Case Rep. 2018;49:8-13. PMID: 29920412; PMCID: PMC6005793. https://doi.org/10.1016/j.ijscr.2018.05.023
- Nguyen C.L., Lindsay A., McLachlan R., Islam S., Qasabian R., Loa J. Aortoduodenal fistula 2 years after elective endovascular repair of an abdominal aortic aneurysm. ANZ J Surg. 2020;90(11):2374-2376. PMID: 32077559. https://doi.org/10.1111/ans.15773
- Kahlberg A., Rinaldi E., Piffaretti G., Speziale F., Trimarchi S., Bonardelli S., Melissano G., Chiesa R., MAEFISTO collaborators. Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). J Vasc Surg. 2016;64(2):313-320.e1. PMID: 27289529. https://doi.org/10.1016/j.jvs.2016.04.008
- Zaki M., Tawfick W., Alawy M., ElKassaby M., Hynes N., Sultan S. Secondary aortoduodenal fistula following endovascular repair of inflammatory abdominal aortic aneurysm due to Streptococcus anginosus infection: a case report and literature review. Int J Surg Case Rep. 2014;5(10):710-713. PMID: 25201477; PMCID: PMC4189064. https://doi.org/10.1016/j.ijscr.2013.10.016
- Куликовский В.Ф., Шевцов Ю.Н., Карпачев А.А., Солошенко А.В., Ярош А.Л., Лопин А.В., Мухачев Д.Л., Касьянов Б.В. Желудочно-кишечное кровотечение, вызванное ложной симптомной аневризмой инфраренального отдела брюшной аорты. Хирургия. Журнал им. Н.И. Пирогова. 2017;(3):102-103. [Kulikovsky V.F., Shevtsov Yu.N., Karpachev A.A., Soloshenko A.V., Yarosh A.L., Lopin A.V., Mukhachev D.L., Kasyanov B.V. Gastrointestinal bleeding caused by false symptomatic infrarenal abdominal aortic aneurysm. Pirogov Russian Journal of Surgery. 2017;(3):102-103. (In Russ.)] https://doi.org/10.17116/hirurgia20173102-103
- Тимен Л.Я. Клинико-эндоскопические наблюдения первичной аорто-эзофагеальной фистулы. Описание двух случаев. Русский медицинский журнал. Медицинское обозрение. 2015;23(17):1060-1062. [Timen L.Ya. Clinical and endoscopic observations of the primary aortoesophageal fistula. Description of two cases. Russian Medical Journal. 2015;23(17):1060-1062. (In Russ.)]
- Bergqvist D., Björkman H., Bolin T., Dalman P., Elfström J., Forsberg O., Johansen L., Karacagil S., Karlqvist P.A., Länne T., Plate G., Ribbe E., Spangen L., Stenbaek J., Thomsen M., Wiklund B., Angquist K.A. Secondary aortoenteric fistulae – changes from 1973 to 1993. Eur J Vasc Endovasc Surg. 1996;11(4):425-428. PMID: 8846176. https://doi.org/10.1016/s1078-5884(96)80175-4
- Ichita Ch., Sasaki A., Sumida Ch., Kimura K., Nishino T., Tasaki J., Masuda S., Koizumi K., Kawachi J., Kako M. Clinical and endoscopic features of aorto-duodenal fistula resulting in its definitive diagnosis: an observational study. BMC Gastroenterol. 2021;21(1):45. PMID: 33526013; PMCID: PMC7851914. https://doi.org/10.1186/s12876-021-01616-9
- Song Y., Liu Q., Shen H., Jia X., Zhang H., Qiao L. Diagnosis and management of primary aortoenteric fistulas – experience learned from eighteen patients. Surgery. 2008;143(1):43-50. PMID: 18154932. https://doi.org/10.1016/j.surg.2007.06.036
- Shahrokh Sh., Zali M.R. An unusual cause of upper gastrointestinal bleeding. Gastroenterol Hepatol Bed Bench. 2014;7(3):183-185. PMID: 25120901; PMCID: PMC4129571.
- Gurakar M., Shah P., Kaspar M. Contained aortic rupture with hematoma and gastrointestinal bleeding. Clin Gastroenterol Hepatol. 2020;18(2):e19-e20. PMID: 31941598. https://doi.org/10.1016/j.cgh.2018.10.039
- Nazarewicz G.V., Jain R. Upper gastrointestinal bleeding caused by aortoesophageal fistula. Clin Gastroenterol Hepatol. 2016;14(12):A22. PMID: 27546580. https://doi.org/10.1016/j.cgh.2016.08.013
- Bala M., Sosna J., Appelbaum L., Israeli E., Rivkind A.-I. Enigma of primary aortoduodenal fistula. World J Gastroenterol. 2009;15(25):3191-3193. PMID: 19575502; PMCID: PMC2705745. https://doi.org/10.3748/wjg.15.3191
- Tomouk T., Kusumawidjaja D., Libzo N. A rare cause of melena with an unusual finding on gastroscopy. Clin Gastroenterol Hepatol. 2016;14(1):e3-e4. PMID: 26001335. https://doi.org/10.1016/j.cgh.2015.05.024
- Vu Q.D.M., Menias C.O., Bhalla S., Peterson C., Wang L.L., Balfe D.M. Aortoenteric fistulas: CT features and potential mimics. Radiographics. 2009;29(1):197-209. PMID: 19168845. https://doi.org/10.1148/rg.291075185
- Luo J., Tang W., Wang M., Xiao Y., Tan M., Jiang Ch. Case series of aortoenteric fistulas: a rare cause of gastrointestinal bleeding. BMC Gastroenterol. 2021;21(1):49. PMID: 33530944; PMCID: PMC7856786. https://doi.org/10.1186/s12876-021-01629-4
- Белов Д.В., Гарбузенко Д.В., Лукин О.П., Ануфриева С.С. Синдром Хейда, как редкая причина желудочно-кишечных кровотечений у больных с аортальным стенозом. Кардиоваскулярная терапия и профилактика. 2021;20(1):2503. [Belov D.V., Garbuzenko D.V., Lukin O.P., Anufrieva S.S. Heyde’s syndrome as a rare cause of gastrointestinal bleeding in aortic stenosis patients. Cardiovascular Therapy and Prevention. 2021;20(1):2503. (In Russ.)] https://doi.org/10.15829/1728-8800-2021-2503
- Saers S.J.F., Scheltinga M.R.M. Primary aortoenteric fistula. Br J Surg. 2005;92(2):143-152. PMID: 15685700. https://doi.org/10.1002/bjs.4928
- Панасюк А.И., Кыштымов С.А., Иноземцев Е.О., Григорьев Е.Г. Вторичный аорто-дуоденальный свищ. Рецидивирующее кровотечение. Трудности топической диагностики и лечебно-тактические ошибки (случай из клинической практики). Актуальные проблемы медицины. 2020;43(1):146-154. [Panasyuk A.I., Kyshtymov S.A., Inozemcev E.O., Grigoryev E.G. Secondary aorto-duodenal fistula. Recurrent bleeding. Difficulties of topical diagnosis and tactical errors (case from clinical practice). Challenges in Modern Medicine. 2020;43(1):146-154. (In Russ.)] https://doi.org/10.18413/2687-0940-2020-43-1-146-154
- Kim B.Y., Kim K.B. Primary aortoduodenal fistula causes massive melena: A case report. Korean J Gastroenterol. 2021;77(3):132-135. PMID: 33758109. https://doi.org/10.4166/kjg.2021.006
- Joshi G., Ogbudinkpa Ch., Stecher J., Khoury R.E., Resnick D.J., Jacobs Ch.E., White J.V., Schwartz L.B. Treatment of post-evar aortoduodenal fistula without endograft excision. Vasc Endovascular Surg. 2021;55(3):282-285. PMID: 33047669. https://doi.org/10.1177/1538574420966455
- Kakkos S.K., Bicknell C.D., Tsolakis I.A., Bergqvist D. Editor's choice – Management of secondary aorto-enteric and other abdominal arterio-enteric fistulas: A review and pooled data analysis. Eur J Vasc Endovasc Surg. 2016;52(6):770-786. PMID: 27838156. https://doi.org/10.1016/j.ejvs.2016.09.014
- Spanos K., Kouvelos G., Karathanos C., Matsagkas M., Giannoukas A.D. Current status of endovascular treatment of aortoenteric fistula. Semin Vasc Surg. 2017;30(2-3):80-84. PMID: 29248124. https://doi.org/10.1053/j.semvascsurg.2017.10.004
- Ranasinghe W., Loa J., Allaf N., Lewis K., Sebastian M.G. Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg. 2011;25(3):386.e1-386.e5. PMID: 21269801. https://doi.org/10.1016/j.avsg.2010.09.021
- Rodrigues dos Santos C., Casaca R., Mendes de Almeida J.C., Mendes-Pedro L. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014;28(3):756-762. PMID: 24456836. https://doi.org/10.1016/j.avsg.2013.09.004
- Alzobydi A.H., Guraya Sh.S. Primary aortoduodenal fistula: a case report. World J Gastroenterol. 2013;19(3):415-417. PMID: 23372367; PMCID: PMC3554829. https://doi.org/10.3748/wjg.v19.i3.415
