# Two Cases of Primary Aortoenteric Fistulas Diagnosed by Computed Tomography

## TL;DR

This paper reports two rare cases of aortoenteric fistulas diagnosed using CT scans, highlighting the importance of rapid diagnosis and surgery for better outcomes.

## Contribution

The paper contributes two clinical case reports demonstrating the utility of CTA in diagnosing primary aortoenteric fistulas.

## Key findings

- Computed tomography angiography (CTA) identified gas in the aortic lumen, suggesting aortoenteric fistulas in both cases.
- Prompt surgical intervention following CTA diagnosis led to successful outcomes in both patients.
- One patient experienced postoperative complications, including duodenal repair breakdown and colonic ischemia.

## Abstract

A primary aortoenteric fistula is a rare clinical entity that leads to severe upper gastrointestinal bleeding and carries a high risk of mortality, yet diagnosing aortoenteric fistulas remains challenging. Diagnosis is frequently delayed due to the uncommon and non-specific nature of the abdominal signs and symptoms. Rapid diagnosis and prompt surgical intervention are paramount to the successful management of this condition which is known for its profoundly poor prognosis. This report describes two cases of primary aortoenteric fistulas, one of which presented with melena and hematemesis, and the other presented with hematemesis and abdominal pain. In both cases, computed tomography angiography (CTA) demonstrated findings suggestive of an aortoenteric fistula, namely, locules of gas within the aortic lumen, which led to emergent surgical intervention. One patient underwent esophagogastroduodenoscopy while in the operating room before surgical intervention. One patient underwent repair with axillo-bifemoral bypass and the other with juxtarenal abdominal aortic aneurysm repair with a rifampin-soaked gelsoft dacron graft followed by primary bowel repair. Postoperative complications for one of the patients included duodenal repair breakdown as well as colonic ischemia. One patient made a meaningful recovery and remained without complications until the first postoperative visit two months after the repair. The other patient was discharged and then subsequently lost to follow-up. The two patients’ successful outcomes of such a lethal condition were in large part due to rapid diagnosis with CTA and prompt surgical intervention.