Primary Aorto-Digestive Fistula: A Case Report from Madagascar

Abstract

Primary aortodigestive fistulas (ADF) are rare abnormal communications between the native aorta and the gastrointestinal tract. We report the case of a 54-year-old hypertensive woman, untreated, with a history of hemorrhagic antral-pyloric ulcer. She had presented with recurrent ulcer pain and a pulsatile abdominal mass for four months. Her treatment consisted of traditional abdominal massage. On admission, she presented with hypovolemic shock secondary to massive digestive hemorrhage, with severe anemia. Abdominal angio-CT revealed a suprarenal aortic aneurysm with gastric fistulization. Despite resuscitation measures, the outcome remained unfavorable due to the lack of surgical management, which is linked to limited resources in Madagascar. Primary ADF are a rare but fatal cause of gastrointestinal bleeding. They should be suspected in patients presenting with the classic triad: gastrointestinal hemorrhage, abdominal pain, and a pulsatile abdominal mass.