IMAGES IN EMERGENCY MEDICINE
Secondary aortoenteric fistula presenting with small bowel obstruction
1 Department of Radiology, St Vincent’s University Hospital, Dublin 4, Ireland
2 Department of Vascular Surgery, St Vincent’s University Hospital, Dublin 4, Ireland
Correspondence to:
Correspondence to Dr R Killeen, Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; rokilleen@yahoo.com
Accepted 16 May 2008
| The first 150 words of the full text of this article appear below. |
A 79-year-old woman presented with colicky abdominal pain on a background of previous aortic aneurysm graft insertion 3 years earlier. Physical examination disclosed hyperactive bowel sounds and epigastric discomfort. Abdominal multidetector computed tomography (MDCT) was performed with intravenous contrast for suspected small bowel obstruction. This revealed an aortoenteric fistula (AEF) with secondary clot obstruction of the small and large bowel (fig 1). The patient underwent emergency surgery and made a full recovery.
Figure 1 (A) Coronal multidetector CT scan showing a distal aortic pseudoaneurysm (arrow) which abuts the jejunum at the site of aortoenteric fistula. The small bowel loops and cecum are distended with intraluminal clots (asterisk).
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Secondary AEFs may occur 8 months to 15 years after graft placement but occur in <1%. Gastrointestinal bleeding is the most common presentation.1 Imaging features on MDCT include perigraft fluid, perigraft soft tissue or air and pseudoaneurysm formation. Treatment involves graft excision and
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