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Aortoenteric fistula: a diagnostic dilemma

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Abstract

Objective

To assess the sensitivity and specificity of computed tomography (CT) in the diagnosis of aortoenteric fistula (AEF) and to determine the most accurate CT signs of the disease.

Methods

Hospital records were reviewed over a 20-year period. Twenty-three patients in whom a final diagnosis of AEF was made at laparotomy or autopsy were identified. Ten of these had CT performed. Twelve control cases were also collected. The 22 cases, (10 cases of AEF and 12 controls), were reviewed retrospectively by two independent readers, who were blinded to the clinical features and outcome. Each case was examined for six specific radiological findings. The outcome of other adopted investigative modalities was also examined.

Results

The presence of peri-aortic ectopic gas (>2 weeks following surgery) in the context of gastrointestinal (GI) blood loss was 100% specific for AEF. If AEF was considered to be present where signs of peri-aortic infection were present in a patient with GI bleeding, CT had an overall specificity of 100% (95% confidence interval = 1.0–1.0) and sensitivity of 50%.

Conclusion

CT can rule in the diagnosis of AEF but cannot rule it out. CT is recommended as the first-line investigation in a stable patient with suspected AEF.

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Author notes

  1. Fiona M. Hughes

    Present address: UCSD Medical Center, San Diego, California, 92103, USA

Authors and Affiliations

  1. Department of Radiology, St Vincent’s University Hospital, Dublin 4, Ireland

    Fiona M. Hughes, Anthony Owens, Donal P. MacErlaine & Dermot E. Malone

  2. Department of General Surgery, St Columcille’s Hospital, Co. Dublin, Ireland

    Dara Kavanagh

  3. Department of Vascular Surgery, St Vincent’s University Hospital, Dublin 4, Ireland

    Mary Barry

Authors
  1. Fiona M. Hughes
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  2. Dara Kavanagh
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  3. Mary Barry
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  4. Anthony Owens
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  5. Donal P. MacErlaine
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  6. Dermot E. Malone
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Corresponding author

Correspondence to Fiona M. Hughes.

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Hughes, F.M., Kavanagh, D., Barry, M. et al. Aortoenteric fistula: a diagnostic dilemma. Abdom Imaging 32, 398–402 (2007). https://doi.org/10.1007/s00261-006-9062-7

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  • DOI: https://doi.org/10.1007/s00261-006-9062-7

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