Nghe An General Friendship Hospital: Successful surgery on a rare case - primary gastrointestinal aortic fistula

On August 22, 2022, patient PTH (male, 61 years old, Hung Dao commune, Hung Nguyen district) was admitted to the Department of Internal Medicine and Gastroenterology.Nghe An General Friendship Hospitalin a state of epigastric pain, frequent black stools. The patient was diagnosed with moderate upper gastrointestinal bleeding.

Surgery for aorto-gastrointestinal fistula is extremely rare. Photo: BVCC

Through medical history, the patient had suffered from gastrointestinal bleeding many times, and examination and treatment in many places could not find the cause and location of the bleeding. In July 2022, the patient was hospitalized for hemorrhagic shock, the patient was diagnosed with a tear in the cardia, suspected of abnormal submucosal bleeding (Dieulafoy's disease), and was treated with a clip, and the condition was stable.

Abdominal aortic pseudoaneurysm with surrounding fat infiltration, followed by communication into D3 duodenum. Photo: BVCC

Immediately upon admission, PTH patient was prescribed a blood transfusion and a consultation was conducted, the entire department agreed on the diagnosis of gastrointestinal bleeding.- follow-up due to mid-gastrointestinal bleeding. After 64-slice computed tomography with angiography, the lesion was found to be a pseudoaneurysm of the abdominal aorta below the renal artery with extensive surrounding infiltration, suspected to have a connection to the D3 duodenum.

On August 29, 2022, the patient underwent surgery in parallel by two teams. The gastroenterology team was performed by Master Tang Huy Cuong. The patient had the D3 duodenal fistula excised and the digestive tract restored. At the same time, the vascular surgery team led by Master Pham Van Chung performed ligation of the abdominal aorta above and below the pseudoaneurysm, bypassing extra-anatomical arteries (axillary - femoral, femoral - femoral).

After 5 days, the patient was able to sit up and eat, there was no more gastrointestinal bleeding, and the digestive system functioned normally. The patient recovered and was discharged from the hospital 2 weeks after surgery.

CT scan image after axillary-femoral and femoral-thigh bypass surgery with good circulation. Photo: BVCC

According to Master Pham Van Chung: “Aorto-gastrointestinal fistula is a very serious disease, requiring early diagnosis and multidisciplinary emergency treatment. CT scans are highly valuable in detecting lesions. Abdominal aortic ligation surgery, extra-anatomical vascular bypass combined with treatment of gastrointestinal lesions is a highly successful solution.”

Aorto-gastrointestinal fistula is divided into 2 groups: The secondary lesion group is considered a complication after surgery or intervention of the abdominal aorta or gastrointestinal surgery, occurring at a rate of about 0.7 - 1.7% of the causes of gastrointestinal bleeding; the primary lesion group is extremely rare, accounting for only 0.04 - 0.07%.

The patient recovered and was discharged from the hospital after 2 weeks of surgery. Photo: BVCC

First timeNghe An General Friendship Hospitalperformed the extremely rare Aorto-gastrointestinal fistula surgery, under the coordination of many specialties and the efforts of the surgical team as well as staff from the Departments of Gastroenterology, Cardiothoracic Surgery and Resuscitation, with absolutely successful results. This is a big step forward in the journey of building and developing technical expertise at the hospital./.