The Teaching Point

Inflammatory abdominal aortic aneurysm is a rare cause for primary aortoenteric fistula and its consequences are catastrophic if not promptly managed. While rare, the presence of a contrast jet from the aorta to the duodenum is diagnostic of an aortoenteric fistula.






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From the manuscript

Aortoenteric fistula secondary to an Inflammatory Abdominal Aortic Aneurysm

Free full text article: Aortoenteric fistula secondary to an  Inflammatory Abdominal Aortic Aneurysm

Abstract
Primary aortoenteric fistulas are rare, with the annual incidence of such fistulas estimated to be 0.007 per million. The most common predisposing conditions for primary aortoenteric fistulas are atherosclerotic abdominal aortic aneurysms or penetrating atherosclerotic ulcers. We illustrate a rare case of an inflammatory aortic aneurysm causing a primary aortic fistula, with a direct fistulous jet from the aorta to the bowel with resultant catastrophic bleeding. In contrast to atherosclerotic aneurysms, most inflammatory aneurysms are symptomatic and show dense perianeurysmal fibrosis and periaortic wall thickening. A direct jet of contrast extravasation from the aorta into a bowel loop, while rarely seen, remains the most specific sign of a primary aorta-enteric fistula. A comprehensive literature review of the clinical presentation, imaging features, and differential diagnosis of a primary aortoenteric fistula are also discussed.






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