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Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding  [cached]
Samira Ineida Morais Gomes,Fernando Peixoto Ferraz de Campos,Brenda Margatho Ramos Martines,Jo?o Augusto dos Santos Martines
Autopsy and Case Reports , 2011,
Abstract: Acute upper gastrointestinal bleeding is a potentially life-threatening emergency, especially in the elderly. This condition accounts for approximately 1% of all emergency room admissions. Among the causes of such bleeding is aortoesophageal fistula, a dreaded but apparently rare condition, first recognized in 1818. The great majority of cases are of primary aortoesophageal fistula, caused by atheromatous aortic aneurysms or, less frequently, by penetrating aortic ulcer. The clinical presentation of aortoesophageal fistula is typically characterized by the so-called Chiari’s triad, consisting of thoracic pain followed by herald bleeding, a variable, short symptom-free interval, and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospital mortality rate being 60%. Conservative treatment does not prolong survival, and the in-hospital mortality rate is 40% for patients submitted to conventional surgical treatment. Here, we report the case of a 93-year-old woman who presented to the emergency room with a history of hematemesis. The patient was first submitted to upper gastrointestinal endoscopy, the findings of which were suggestive of aortoesophageal fistula. The diagnosis was confirmed by multidetector computed tomography of the chest. Surgery was indicated. However, on the way to the operating room, the patient presented with massive bleeding and went into cardiac arrest, which resulted in her death.
Fístula colecistocólica: una causa poco frecuente de hemorragia digestiva baja Cholecistocolic fistula: an uncommon cause of lower gastrointestinal bleeding  [cached]
M. Ostiz,J.J. Vila,J.L. García Sanchotena,S. Ostiz
Anales del Sistema Sanitario de Navarra , 2012,
Abstract: La fístula colecistocólica es un tipo poco común de fístula bilioentérica que tiene una presentación clínica variable y que generalmente aparece como complicación de la enfermedad litiásica biliar. Puede manifestarse en forma de dolor abdominal, náuseas, pérdida de peso, diarrea con o sin esteatorrea asociada, clínica dispéptica y más raramente como hemorragia digestiva baja, colangitis de repetición o incluso como un ileo biliar. Las técnicas más útiles para el diagnóstico son el TC abdominal, los estudios baritados y la colangiopancreatografía retrógrada endoscópica (CPRE). Describimos el caso de una mujer de edad avanzada, pluripatológica, con fístula colecistocólica, que se presentó en forma de hemorragia digestiva baja. Fue estudiada mediante colonoscopia, TC abdominal y enema de bario. Durante el ingreso requirió transfusión de 4 concentrados de hematíes, desestimándose el tratamiento invasivo debido a su comorbilidad de base. Evolucionó favorablemente, con resolución espontanea del cuadro. Dos meses después permanecía asintomática. Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrhoea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal haemorrhage and even with a gallstone ileous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asymptomatic two months later.
Massive Lower Gastrointestinal Bleeding from an External Iliac Artery Fistula in a Patient with Bladder Cancer  [PDF]
Chih-Chien Chin,Chien-Yuh Yeh,Yi-Hung Kuo,Jeng-Yi Wang
Chang Gung Medical Journal , 2008,
Abstract: Arterioenteric fistula is a rare cause of lower gastrointestinal bleeding, yet it can potentiallycause massive, life-threatening bleeding. Patients with an advanced pelvic malignancycan develop hemorrhage from an arterioenteric fistula. Selective mesenteric angiography isunable to demonstrate the source of bleeding in these patients, so evaluation of the iliacarteries is essential. We present a 67-year old man with advanced bladder cancer presentingas massive, life-threatening lower gastrointestinal bleeding from an external iliac arterial fistulato the cecum.
Gastrointestinal bleeding caused by extrahepatic arterioportal fistula associated with portal vein thrombosis  [cached]
Ling Nie,Xue-Feng Luo,Xiao Li
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i44.6501
Abstract: An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.
Gastric Duplication: A Rare Cause of Massive Lower Gastrointestinal Haemorrhage, Chest Wall Mass, and Enterocutaneous Fistula
Emeka B. Kesieme,Andrew E. Dongo,Clement O. Osime,Sylvia C. Olomu,Oluwafemi O. Awe,Gerald I. Eze,Sylvester U. Eluehike
Case Reports in Gastrointestinal Medicine , 2012, DOI: 10.1155/2012/250890
Abstract: Gastric duplications are uncommon developmental abnormality reported to present with different clinical scenarios. We present a 2-1/2-year-old Nigerian female who started having intermittent massive lower gastrointestinal haemorrhage at 5 months of age. She subsequently developed a lower chest wall mass and enterocutaneous fistula. She was found to have gastric duplication with fistulous communication with the descending colon, spleen, and lower chest wall. To the best of our knowledge, this is the first paper on gastric duplication resulting in intermittent massive lower gastrointestinal bleeding mainly from splenic capsular erosion and fistula and enterocutaneous fistula resulting from erosion of anterior abdominal wall. Gastric duplication is hence an important rare cause of intermittent massive lower gastrointestinal haemorrhage and spontaneous enterocutaneous fistula in the paediatric population.
Surviving a Catastrophic Upper Gastrointestinal Bleeding Caused by Esophageal-Subclavian Fistula: Case Report  [PDF]
Khalid Y. Nabrawi, Mohamed-Elbagir K. Ahmed, Abdulrahman Y. Asiri, Shaima M. Al-Aoun, Abdullah M. Alshehri, Abdullah H. Alhaizaey, Musaad A. Alghamdi, Ali S. Alahmari
Open Journal of Gastroenterology (OJGas) , 2018, DOI: 10.4236/ojgas.2018.86023
Abstract: Arterio-esophageal fistula (AEF), whether congenital or acquired, is a rare condition which can lead to fatal upper gastrointestinal bleeding. We report here a young man who developed a subclavian-esophageal fistula (SEF) secondary to chicken bone impaction in the upper esophagus. The diagnosis was reached by urgent upper endoscopy and Computed Tomography of the chest which showed pseudo-aneurysmal changes at left subclavian artery with leaked contrast through the fistula towered the esophagus. Urgent endo-vascular angiography confirmed the subclavian arterio-esophageal fistula that was managed uneventfully using covered 6mm Viban stent-graft. The patient survived this serious condition and was discharged home in good condition.
Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula
Tasbirul Islam, George Hines, Douglas S. Katz, William Purtil and Francis Castiller
Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine , 2012,
Abstract: We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.
Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula
Tasbirul Islam,George Hines,Douglas S. Katz,William Purtil
Clinical Medicine : Circulatory, Respiratory and Pulmonary Medicine , 2008,
Abstract: We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.
Massive upper gastrointestinal bleeding due to esophago- thyroidal artery fistula following foreign body aspiration: a case report
Bagheri R.,Maddah Gh.,Abdollahi A.
Tehran University Medical Journal , 2007,
Abstract: Background: Immediate treatment when an esophageal foreign body is suspected is critical because of the possibility of serious complications. The presence of foreign bodies in the esophagus usually occurs accidentally in children and mentally retarded adults. A greater risk of perforation of the esophagus, development of a mediastinal, as well as airway compromise is present when a foreign body is lodged longer than 24 hours. Furthermore, this condition results in complications, such as hemorrhage or esophageal fistula, when treatment is delayed. We herein report a case of esophageo-thyroidal artery fistula, a rare complication resulting from the delayed removal of an esophageal foreign body. Patient presentation: A 34 year-old female who had swallowed her dental prosthesis one week previously was referred for severe gastrointestinal bleeding. Surgery to remove the foreign body was performed. To determine the cause of continued bleeding after the endoscopy and angiography, we performed a neck exploration, which revealed hemorrhage from a fistula between thyroid vessels and the esophagus. After surgical resection of the fistula, the patient was discharged from the hospital in good condition and has had no related problems for six months.Conclusions: Considering the complications resulting from the delay of the removal of foreign bodies from the esophagus, these objects should be removed as soon as possible.
Splenic Arteriogastric Fistula Resulting from Adrenocortical Carcinoma: A Rare Cause of Massive Upper Gastrointestinal Hemorrhage  [PDF]
Elias J. Dayoub, Kyung J. Cho
Open Journal of Radiology (OJRad) , 2013, DOI: 10.4236/ojrad.2013.34027

Splenic arteriogastric fistula is a rare cause of upper gastrointestinal (GI) hemorrhage, only reported a handful of times in the literature. Herein, we present a case of a 49-year-old woman with metastatic adrenocortical carcincoma who developed a fistula between the splenic artery and gastric lumen as a result of local invasion of her primary tumor. This fistula led to several episodes of massive upper GI bleeding. Selective splenic artery embolization was successful in ceasing the GI bleed; however, the intervention was not timely enough for the patient to survive the hemorrhage. We outline several clinical and imaging findings to assist physicians with earlier detection of splenic arteriogastric fistulas, and advocate prophylactic selective splenic artery embolization when this rare but highly fatal entity is discovered.

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