Dataset Information

Double-barrel plugging in a recurrent aorto-enteric fistula.

ABSTRACT: Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation.

Supplementary information

The online version contains supplementary material available at 10.1007/s12055-022-01342-1.

SUBMITTER: Ayyappan A

PROVIDER: S-EPMC9218023 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Double-barrel plugging in a recurrent aorto-enteric fistula.

Ayyappan Anoop A Valakkada Jineesh J Bursupalle Mahesh Reddy MR Kannath Santhosh Kumar SK Pitchai Shivanesan S

Indian journal of thoracic and cardiovascular surgery 20220322 4

Aorto-enteric fistulas (AEF) are uncommon causes of gastrointestinal bleeding. Both surgical and endovascular options are described for the management of AEF. A hybrid approach is recommended in cases of recurrent AEF. Herein we present a patient with recurrent secondary AEF with severe hypotension, melaena, and hematemesis, who underwent embolization of the residual aortic stump with the parallel placement of two vascular plugs and onyx for control of the situation.<h4>Supplementary information ...[more]

PMID: 35756567

Similar Datasets

Project description:IntroductionAlarming outcomes have been reported following infected endovascular aortic aneurysm repair (EVAR) device explantation. Infected fenestrated EVAR (FEVAR) exposes patients to even worse procedural risks.ReportA 67 year old man with a prior history of FEVAR presented with impaired general condition, abdominal and back pain, and increased C reactive protein. Computed tomography angiography revealed a collection around the aortic graft bifurcation and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed increased FDG uptake at this level, confirmed by labelled white blood cells, all favouring graft infection. A thoracophrenolumbotomy was performed and revealed an aorto-enteric fistula which was treated by small bowel resection. The left renal artery was transected at the distal end of the bridging stent and a thoracorenal bypass was performed. The thoracic aorta was cross clamped above the coeliac trunk for complete graft excision. Meanwhile, the right kidney was perfused with 4°C Ringer lactate solution. In situ reconstruction was accomplished with a bifurcated antimicrobial graft sutured below the superior mesenteric artery with re-implantation of the right renal artery. The patient was left with a laparostomy for definitive abdominal closure, restoration of the digestive tract, and omental wrap 72 hours later. Broad spectrum antibiotic therapy was initiated peri-operatively and reduced to sulfamethoxazole/trimethoprim for a total duration of six weeks after one sample was positive for Moraxella osloensis. Eleven months later, the patient was free from re-infection, with no fever or inflammatory syndrome.DiscussionTotal explantation of stent grafts with tissue debridement and post-operative antibiotic therapy is the gold standard when dealing with infected EVAR. As with type IV thoraco-abdominal aneurysm open repair, FEVAR device explantation requires additional protective measures to prevent visceral ischaemia and renal impairment. In agreement with the European Society for Vascular Surgery guidelines, such patients should be referred to dedicated vascular centres with expertise in surgical repair, anaesthetics, and post-operative intensive care.

Project description:BackgroundAorta-pulmonary (A-P) artery fistula following a stab wound to the chest with superimposed infective endocarditis (IE) is a rare, often unrecognized presentation. Herein, we report a case of A-P fistula due to stab chest assessed by two- and three-dimensional (3D) imaging.Case summaryA 30-year-old man presented with a history of being stabbed in the chest with a screwdriver. The chest wall laceration was sutured, an intercostal drain inserted for a haemopneumothorax, and he was subsequently discharged. He presented 3 weeks later with exertional dyspnoea, fever, rigours, and loss of weight. On examination, he had a wide pulse pressure and a harsh continuous murmur in the 2nd left intercostal space associated with a palpable thrill. Blood tests revealed raised infective markers and anaemia. All blood cultures were sterile. On echocardiography, the aortic and pulmonary valve was severely damaged, with suspicion of superimposed vegetations secondary to IE. There was severe aortic and pulmonary valve regurgitation. A fistulous connection was noted between the aorta and main pulmonary artery, just below the commissure adjoining the right and left coronary sinus of the aortic valve. On 3D imaging, the defect was quantified. The patient was subsequently referred for aortic and pulmonary valve replacement and closure of the A-P fistula. The presence of multiple vegetations was confirmed intraoperatively. He also received a 6-week course of intravenous antibiotics.DiscussionWe have described a rare case of an A-P fistula due to a stab wound to the chest complicated by IE. In a patient with stab wound to the chest, a high index of suspicion of cardiac involvement must be maintained, and a careful search for intracardiac shunts must be made on echocardiography, prior to discharge. Furthermore, in addition to two-dimensional imaging, 3D imaging proved useful in providing a comprehensive assessment of the morphology of the lesion prior to surgery.

Dataset Information

Double-barrel plugging in a recurrent aorto-enteric fistula.

Supplementary information

Publications

Double-barrel plugging in a recurrent aorto-enteric fistula.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets