Primary aortodigestive fistulas (ADF) are rare abnormal communications between the native aorta and the gastrointestinal tract. We report the case of a 54-year-old hypertensive woman, untreated, with a history of hemorrhagic antral-pyloric ulcer. She had presented with recurrent ulcer pain and a pulsatile abdominal mass for four months. Her treatment consisted of traditional abdominal massage. On admission, she presented with hypovolemic shock secondary to massive digestive hemorrhage, with severe anemia. Abdominal angio-CT revealed a suprarenal aortic aneurysm with gastric fistulization. Despite resuscitation measures, the outcome remained unfavorable due to the lack of surgical management, which is linked to limited resources in Madagascar. Primary ADF are a rare but fatal cause of gastrointestinal bleeding. They should be suspected in patients presenting with the classic triad: gastrointestinal hemorrhage, abdominal pain, and a pulsatile abdominal mass.
References
[1]
Cooper, A. (1839) Lectures on Principles and Practice of Surgery with Additional Notes and Cases by F. Tyrrell. 5th Edition, Haswell, Barrington, and Haswell Publisher.
[2]
Ishimine, T., Tengan, T., Yasumoto, H., Nakasu, A., Mototake, H., Miura, Y., et al. (2018) Primary Aortoduodenal Fistula: A Case Report and Review of Literature. International Journal of Surgery Case Reports, 50, 80-83. https://doi.org/10.1016/j.ijscr.2018.07.019
[3]
Lozano, F.S., Muñoz-Bellvis, L., San Norberto, E., Garcia-Plaza, A. and Gonzalez-Porras, J.R. (2008) Primary Aortoduodenal Fistula: New Case Reports and a Review of the Literature. Journal of Gastrointestinal Surgery, 12, 1561-1565. https://doi.org/10.1007/s11605-008-0499-6
[4]
Kane, J.M. Meyer, K.A. and Kozoll, D.D. (1955) An Anatomical Approach to the Problem of Massive Gastrointestinal Hemorrhage. Archives of Surgery, 70, 570-582. https://doi.org/10.1001/archsurg.1955.01270100096017
[5]
Lemos, D.W., Raffetto, J.D., Moore, T.C. and Menzoian, J.O. (2003) Primary Aortoduodenal Fistula: A Case Report and Review of the Literature. Journal of Vascular Surgery, 37, 686-689. https://doi.org/10.1067/mva.2003.101
[6]
Voorhoeve, R., Moll, F.L., de Letter, J.A.M., Bast, T.J., Wester, J.P.J. and Slee, P.H.T.J. (1996) Primary Aortoenteric Fistula: Report of Eight New Cases and Review of the Literature. Annals of Vascular Surgery, 10, 40-48. https://doi.org/10.1007/bf02002340
[7]
Luo, J., Tang, W., Wang, M.G., Xiao, Y., Tan, M.H. and Jiang, C.Y. (2021) Case Series of Aortoenteric Fistulas: A Rare Cause of Gastrointestinal Bleeding. BMC Gastroenterology, 21, Article No. 49. https://doi.org/10.1186/s12876-021-01629-4
[8]
Berry, S.M. and Fischer, J.E. (1996) Classification and Pathophysiology of Enterocutaneous Fistulas. Surgical Clinics of North America, 76, 1009-1018. https://doi.org/10.1016/s0039-6109(05)70495-3
Hickey, N.C., Downing, R., Hamer, J.D., Ashton, F. and Slaney G. (1991) Abdominal Aortic aneurysms Complicated by Spontaneous Iliocaval or Duodenal Fistulae. The Journal of Cardiovascular Surgery, 32, 181-185.
[11]
Nagy, S.W. and Marshall, J.B. (1993) Aortoenteric Fistulas. Postgraduate Medicine, 93, 211-222. https://doi.org/10.1080/00325481.1993.11701727
Gad, A. (1989) Aortoduodenal Fistula Revisited. Scandinavian Journal of Gastroenterology, 24, 97-100. https://doi.org/10.3109/00365528909091322
[14]
Birkett, W., Pouryahya, P. and Meyer, A.D.M. (2020) Bilateral Vertebral Artery Dissection and Cer-Ebellar Stroke: A Rare Complication of Massage. The New Zealand Medical Journal, 133, 88-92.
[15]
Weir, C.B. and Jan, A. (2025) BMI Classification Percentile and Cut Off Points. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK541070/
[16]
Ikonomopoulos, D.C., Spanos, P.K. and Lazarides, D.P. (1986) Pathogenesis of Aortoenteric Fistula. An experimental study. International Angiology, 5, 33-37.
[17]
Gupta, A., Kapoor, D., Vats, R., Bukhari, S.N. and Goel, D. (2025) Primary Aorto-Duodenal Fistula: A Case Report and Review of Literature. Surgery Case Reports, 4, Article 100080. https://doi.org/10.1016/j.sycrs.2024.100080
[18]
Sweeney, M.S. and Gadacz, T.R. (1984) Primary Aortoduodenal Fistula: Manifestation, Diagnosis, and Treatment. Surgery, 96, 492-497.
[19]
Saers, S.J.F. and Scheltinga, M.R.M. (2005) Primary Aortoenteric Fistula. British Journal of Surgery, 92, 143-152. https://doi.org/10.1002/bjs.4928
[20]
Richards, C.R.N., McMurray, R., Criman, E. and Rinehart, S. (2016) Primary Aortoduodenal Fistula: A Rare Entity with Lethal Effects. BMJ Case Reports, 2016, 1-4. https://doi.org/10.1136/bcr-2016-217001
[21]
Varghese, M., Jorgensen, G.T., Aune, C., Bergan, R., Norderval, S. and Moland, J. (2016) Primary Aortoduodenal Fistula—A Case Report and a Review of the Literature. Annals of Vascular Surgery, 34, 271.E1-271.E4. https://doi.org/10.1016/j.avsg.2015.12.013
[22]
Mlynski, A. (2024) Prise en charge des fistules aortodigestives. https://slidetodoc.com/prise-en-charge-des-fistules-aortodigestives-amlie-mlynski.
[23]
Spanos, K., Kouvelos, G., Karathanos, C., Matsagkas, M. and Giannoukas, A.D. (2017) Current Status of Endovascular Treatment of Aortoenteric Fistula. Seminars in Vascular Surgery, 30, 80-84. https://doi.org/10.1053/j.semvascsurg.2017.10.004
