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Aortoenteric fistula (secondary)

Case contributed by Ket Sang Tai
Diagnosis almost certain

Presentation

Previous aorta repair, presented with massive gastrointestinal bleed.

On axial arterial and portal venous phase images, there is fat stranding around the previously repaired aorta, a small pocket of gas within the aorta and a loop of small bowel in contact with the aorta. On the sagittal arterial phase images, there is a small anterior outpouching of contrast and also gas within the aorta.

Case Discussion

This patient who had previous aorta repair presented with a massive gastrointestinal bleed. Although the CT did not show contrast in the fistula tract and bowel, the presence of gas within the aorta and the contact of an adjacent small bowel loop made the diagnosis highly likely.

The patient was treated with an endovascular stent graft as he was not fit for surgery. His bleeding stopped after treatment. 

Case courtesy of Dr Martin Duddy.

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