Diverse Presentation of Secondary Aortoenteric Fistulae

Table 1

Presentation and outcomes of aortoenteric fistulae.

Case #	Presentation	Initial evaluation	Further evaluation/diagnosis	Outcome
(1) 59 M	UGI bleeding	UGI endoscopy: negative	Repeat study 2 months later showed infected graft in duodenum	Excision of infected graft; gastrojejunostomy
(2) 83 F	Fever, coffee-ground emesis, bright red blood per rectum	UGI endoscopy: negative	Episode of rebleeding prompts repeat endoscopy, which shows pulsating duodenal clot. CT reveals gas around aortic graft	Hospital death
(3) 65 M	Massive hematemesis	Emergent laparotomy	Intraoperative findings: fistula with paraaortic abscess eroding aortic and duodenal wall	Unsuccessful resuscitation
(4) 71 M	Coffee-ground emesis, normal hemoglobin	UGI endoscopy: nonbleeding graft in the 3rd portion of duodenum	Emergency laparotomy scheduled	Exsanguination en route to OR
(5) 85 M	Fever, shaking chills	Blood cultures positive for C. albicans and streptococcus spp.	CT revealed periaortic graft gas	Excision of infected graft; right aortofemoral bypass graft