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Case report
Aortoenteric fistula after endovascular mycotic aortic aneurysm exclusion: lessons learned during the COVID-19 era
  1. Ahmed Hassan1,
  2. Aazeb Khan1,
  3. Bella Huasen2 and
  4. Mohamed Banihani1
  1. 1Vascular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
  2. 2Radiology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
  1. Correspondence to Ahmed Hassan; ahmedhassan{at}doctors.net.uk

Abstract

We report a case of aortoenteric fistula 2 years following endovascular aortic aneurysm repair (EVAR) for mycotic aneurysm presenting as upper gastrointestinal bleeding. Initial CT angiogram did not reveal the bleeding or connection to bowel, but endoscopy was suspicious of endograft in the duodenum. Management required a multidisciplinary approach. To stabilise the patient and to control bleeding, a ‘bridging’ endograft extension was performed. This was followed by open surgical removal of the EVAR endograft and lower limb in situ revascularisation. During postoperative recovery, the patient developed atypical, staged multisystemic symptoms (cardiac, pulmonary and neurological). With increasing awareness of the COVID-19 pandemic, the patient was found SARS-CoV-2-positive, which explained the progression of his symptoms. This was also reflected on other case reports in literature later.

  • GI bleeding
  • vascular surgery
  • interventional radiology
  • interstitial lung disease

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-238875

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    Footnotes

    • Contributors AH and AK equally contributed to the writing of the manuscript and data collection. BH revised and updated the manuscript from an interventional radiological point of view. MB provided the idea of the manuscript and the learning points and supervised the first author during writing the manuscript and final revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.