Lee Shuhui Melissa, Lai Yusheng Keefe, Wen Wei David
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
J Radiol Case Rep. 2019 Sep 30;13(9):8-27. doi: 10.3941/jrcr.v13i9.3746. eCollection 2019 Sep.
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.
原发性主动脉肠瘘罕见，此类瘘的年发病率估计为百万分之0.007。原发性主动脉肠瘘最常见的诱发因素是腹主动脉瘤或穿透性动脉粥样硬化溃疡。我们展示了1例罕见的炎症性主动脉瘤导致原发性主动脉瘘的病例，有直接从主动脉至肠管的瘘管喷射，继而引发灾难性出血。与动脉粥样硬化性动脉瘤不同，大多数炎症性动脉瘤有症状，表现为动脉瘤周围致密纤维化和主动脉壁增厚。造影剂从主动脉直接喷射至肠袢，虽然罕见，但仍是原发性主动脉肠瘘最具特异性的征象。本文还讨论了对原发性主动脉肠瘘的临床表现、影像学特征及鉴别诊断的综合文献综述。
