Aortoenteric fistula identified by clinical ultrasound.

Document Type

Article

Publication Date

6-1-2015

Institution/Department

Emergency

Journal Title

The Journal of emergency medicine

MeSH Headings

Aged, Aortic Aneurysm, Abdominal, Gastrointestinal Hemorrhage, Humans, Intestinal Fistula, Male, Point-of-Care Systems, Ultrasonography, Doppler, Color, Vascular Fistula

Abstract

BACKGROUND: Aortoenteric fistula is a rare but serious cause of gastrointestinal bleeding. Early diagnosis and definitive treatment with fistula repair may improve patient outcomes. We report the use of point-of-care ultrasound to identify an aortoenteric fistula in a patient presenting with abdominal pain and shock.

CASE REPORT: A 78-year old man presented to the Emergency Department with abdominal pain and 5 days of minimal hematochezia. He was hypotensive and had diffuse abdominal tenderness. Point-of-care ultrasound was performed, demonstrating an abdominal aortic aneurysm with a hypoechoic projection into a segment of bowel abutting the aorta. Color flow was present through the structure, consistent with an aortoenteric fistula. After resuscitation with red blood cells, computed tomography was performed to confirm the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinical ultrasound has a well-established role in the detection of aortic aneurysm. This case illustrates that point-of-care ultrasound can also be used to rapidly identify an aortoenteric fistula and expedite timely care and surgical evaluation.

ISSN

0736-4679

First Page

699

Last Page

701

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