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©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2008; 14(29): 4701-4704
Published online Aug 7, 2008. doi: 10.3748/wjg.14.4701
Published online Aug 7, 2008. doi: 10.3748/wjg.14.4701
An autopsy case of a primary aortoenteric fistula: A pitfall of the endoscopic diagnosis
Yoko Ihama, Tetsuji Miyazaki, Chiaki Fuke, Department of Legal Medicine, School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Yasushi Ihama, Fukunori Kinjo, Department of Endoscopy, University Hospital, University of the Ryukyus, Okinawa 903-0215, Japan
Ryoji Matayoshi, Hiroshi Kohatsu, Department of Internal Medicine, Okinawa Red Cross Hospital, Okinawa 900-8611, Japan
Author contributions: Ihama Y, Miyazaki T, Fuke C performed the medico-legal autopsy and wrote this paper; Ihama Y, Matayoshi R, Kohatsu H, Kinjo F contributed clinically to this work.
Correspondence to: Yoko Ihama, MD, PhD, Department of Legal Medicine, School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. makino@med.u-ryukyu.ac.jp
Telephone: +81-98-8951141
Fax: +81-98-8951413
Received: April 16, 2008
Revised: June 30, 2008
Accepted: July 7, 2008
Published online: August 7, 2008
Revised: June 30, 2008
Accepted: July 7, 2008
Published online: August 7, 2008
Abstract
A primary aortoenteric fistula (PAEF), defined as a communication between the native aorta and the gastrointestinal tract, is a rare cause of gastrointestinal bleeding. The preoperative diagnosis of PAEF is extremely difficult. Consequently, PAEF may cause sudden and unexpected death. We present an autopsy case of a 68-year-old man who died of massive gastrointestinal bleeding due to a PAEF. Autopsy revealed a pinhole rupture located on the third part of the duodenal mucosa and fistulized into the adjacent abdominal aortic aneurysm (AAA). Our case indicates that the aortoenteric fistula can result in fatal gastrointestinal bleeding. Consequently, a PAEF should be included in the differential diagnosis of gastrointestinal bleeding.
Keywords: Primary aortoenteric fistula, Gastrointestinal bleeding, Herald bleeding, Misleading, Medico-legal autopsy