Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².  A case report focused on imaging aspects of an aortic-enteric fistula (AEF) in a 39-year-old patient with a recent diagnosis of classic Hodgkin Lymphoma with multiple enlarged retroperitoneal lymph nodes. AEF is a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract. Without prompt intervention, the associated mortality approaches 100%. Early clinical suspicion is essential for a successful outcome and the role of imaging is fundamental to diagnose it. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortic-enteric fistula

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².

Aorto-enteric fistula: a case report

CASE PRESENTATION A 39-year-old patient that had a recent diagnosis of classic Hodgkin Lymphoma with  multiple enlarged retroperitoneal lymph nodes, yet to be staged, was admitted to the hospital with intense back pain and  large volume hematemesis. At first assessment, the patient was medicated, stabilized and submitted to esophagogastroduodenoscopy (EGD), which did not  show active bleeding. After a few hours, the patient had another episode of large volume hematemesis with subsequent hemorrhagic shock. Due to the absence of active bleeding at the  EGD  and to the presence of enlarged and suspicious lymph nodes near the second and third portions of the duodenum, as shown in prior abdominal computed tomography (CT) scan (figure 1a), the gastroenterology staff recommended a CT angiography to investigate the bleeding site. The exam showed retroperitoneal heterogeneous collection with gas bubbles around the aorta and contrast leakage from infrarenal aorta into the third duodenum portion (figures 1b and 1c), findings diagnostic for aorto-duodenal fistula. Then, the patient was sent to the hemodynamics department for endovascular repair, which confirmed active bleeding originated from the infrarenal aorta and was successfully corrected with stent insertion and angioplasty (figures 2a, 2b and 2c). DISCUSSION Aorto-enteric fistula (AEF) consists of a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract². Without prompt intervention, the associated mortality approaches 100%¹. The main clinical signs are abdominal pain and an intermittent herald hemorrhage, resulting from repeated tamponation of the fistula by thrombus formation5. Aorto-enteric fistula may be primary or secondary: primary aorto-enteric fistula (PAEF) occurs in patients with no previous aortic surgery or trauma², as in our case; secondary AEF occurs as a complication of aortic reconstructive surgery, being far more common than primary ones. Both categories, however, are relatively rare, with an incidence of 0.02–0.07% for primary and of 1% for secondary fistulas1,2. PAEF are almost always related to a pre-existing aortic aneurysm². Nevertheless, other less common causes can be encountered, like inflammatory or infectious aortitis, actinic lesions, foreign bodies, and abdominal tumors³. The duodenum, especially its third and fourth portions, is the most common site of fistula, representing 80% of the AEF, involving the third portion in two-thirds of cases 3,4. Early clinical suspicion is essential for a successful outcome5. As our patient had no prior history of surgical intervention nor aortic aneurysm, the bleeding was initially investigated by an EGD, to rule out other causes of upper GI bleeding. However, the absence of active bleeding at the EGD does not rule out an aorto-duodenal fistula 5. Moreover, the length of the endoscope does not allow the visualization of the distal duodenum, where the fistula was located. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortoenteric fistula¹. The signs that strongly suggest a PAEF are the loss of continuity and air bubbles in the aortic wall, which are pathognomonic, and the visualization of the contrast within the GI lumen².  A case report focused on imaging aspects of an aortic-enteric fistula (AEF) in a 39-year-old patient with a recent diagnosis of classic Hodgkin Lymphoma with multiple enlarged retroperitoneal lymph nodes. AEF is a pathologic communication between the aortic lumen and any portion of the gastrointestinal tract. Without prompt intervention, the associated mortality approaches 100%. Early clinical suspicion is essential for a successful outcome and the role of imaging is fundamental to diagnose it. Owing to its widespread availability, short acquisition time, and high resolution, CT with intravenous contrast has become the first-line modality for imaging evaluation of suspected aortic-enteric fistula

Seasonal dynamics of Amblyomma cajennense (Fabricius, 1787) sensu stricto in a degraded area of the Amazon biome, with notes on Rickettsia amblyommatis infection

Abstract Background The tick Amblyomma cajennense sensu stricto (A. cajennense s.s.) frequently parasitizes animals and humans in the Amazon biome, in addition to being a vector of Rickettsia amblyommatis. In the present study, we evaluated both the population dynamics of A. cajennense s.s. in a degraded area of the Amazon biome and the presence of rickettsial organisms in this tick population. Methods The study was carried out in a rural area of the Santa Inês municipality (altitude: 24 m a.s.l.), Maranhão state, Brazil. Ticks were collected from the environment for 24 consecutive months, from June 2021 to May 2023. The region is characterized by two warm seasons: a rainy season (November–May) and a dry season (June–October). We characterized the temporal activity of A. cajennense s.s. on the vegetation by examining questing activity for each life stage (larvae, nymphs, adults [males and females]) in relation to the dry and rainy season. Ticks collected in this study were randomly selected and individually tested by a TaqMan real-time PCR assay that targeted a 147-bp fragment of the rickettsial gltA gene. Results Overall, 1843 (62.4%) adults (52.6% females, 47.4% males), 1110 (37.6%) nymphs and 398 larval clusters were collected. All adult females and nymphs were morphologically identified as A. cajennense s.s. Larval activity was observed from April to December, with a peak from June to September (dry season); nymph abundance peaked from September to November (transition period between dry and rainy seasons); and adult ticks were abundant from October to May (spring/summer/early autumn). The infection rate by R. amblyommatis in A. cajennense s.s. ticks was at least 7% (7/99). Conclusion Our data suggest a 1-year generation pattern for A. cajennense s.s., with a well-defined seasonality of larvae, nymphs and adults in the Amazon biome. Larvae predominate during the dry season, nymphs are most abundant in the dry-rainy season transition and adults are most abundant in the rainy season. The presence of R. amblyommatis in adult ticks suggests that animals and humans in the study region are at risk of infection by this species belonging to the spotted fever group of Rickettsia. Graphical Abstrac

O Protagonismo Infantojuvenil nos Processos Educomunicativos

Neste volume “O protagonismo infantojuvenil nos processos educomunicativos”, reunimos 53 artigos que transitam sobre a temática do protagonismo infantojuvenil em diversas experiências e processos educomunicativos e para facilitar sua leitura e busca por temas de seu interesse, eles estão organizados em 8 capítulos que abordam a educomunicação a partir do fazer das crianças e da apropriação da produção midiática. Expressão artística, rádio, vídeo, jornalismo, cultura digital, redes sociais entre outros são os temas abordados pelos autores destes trabalhos. convidamos o leitor a mergulhar nesta jornada educomunicativa, vivendo e revivendo junto conosco essas experiências vividas por outros, refletindo em cada texto sobre como estamos, como evoluímos e como seguimos os passos daqueles que com sua ousadia, amor e luta elaboraram os fundamentos da educomunicação

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data