INTRODUCTION: An  aorto-enteric  fistula  is  a  fistulous communication  between  the  duodenum  and  the  aorta. The  non-traumatic  form,  or  primary  aorto-enteric  fistula (PAEF), is rare and fatal if untreated.  This is a case of PAEF in a Filipino patient who presented with upper gastrointestinal bleeding (UGIB).
CLINICAL PRESENTATION: A  62-year-old  Filipino  sought consult  for  hematemesis  and  melena.  He  had  just  been discharged the previous day and sent home on empiric H. pylori eradication therapy after a week of workup, which included an unremarkable esophagogastroduodenoscopy (EGD). He claimed to be hypertensive but was not taking any maintenance anti-hypertensive medication.
PHYSICAL FINDINGS: Blood  pressure  was  80/50  mmHg,and  cardiac  rate  of  94  bpm.  He  had  pale  palpebral  conjunctivae,  and  pale  nailbeds.Abdominal  exam  was  unremarkable.  Rest  of  physical  exam  was  normal.  Stat hemoglobin was 63 g/dL.
RESULTS: Exploratory  laparotomy  revealed  the  primary aortoduodenal  fistula  at  the  anterolateral  aspect  of  the fourth  segment  of  the  duodenum  (PADF).  Patient  was  started  on  metoprolol  and  atorvastatin.  Axillary  femoro-femoral  bypass,  ligation  of  aorta,  wedge  resection  of  aortoduodenal fistula, duodenorrhaphy, tube jejunostomy completed  was  done.  Post-operative  course  was  complicated by peritonitis and sepsis, and eventually went into arrest on his third week.
SIGNIFICANCE: This is the first case of PAEF in our institution,and possibly in the country. It is an extremely rare condition that has an annual incidence of 0.007 per million. Since its description in 1843, only 250 cases have been reported in literature.
RECOMMENDATIONS: A  high  index  of  suspicion  is  key  to  its diagnosis  and  management.Massive  UGIB,  a  negative  endoscopy, and known aortic aneurysm should raise the suspicion  for  PAEF,  as  prompt  surgical  intervention  is  the only chance for survival among these patients.

Human ; Male ; Middle Aged ; Melena ; Metoprolol ; Hematemesis ; Atorvastatin Calcium ; Aortic Aneurysm ; Duodenal Diseases ; Intestinal Fistula ; Aortic Diseases ; Aorta ; Peritonitis ; Sepsis ; Duodenum ; Hemoglobins

Introduction: COVID-19 emerged as a new disease during the early period of 2020. Given that our institution is a cardiac specialty center and our patients have numerous co-morbidities compared to the general population, we wanted to determine the clinical profiles and in-hospital short-term outcomes of suspect, probable and confirmed adult COVID-19 patients seen at our institution. Methodology: We prospectively enrolled 323 adult (115 health care workers) suspect, probable and confirmed COVID- 19 patients admitted from March to June 2020. We described and analyzed their clinical presentation, and in-hospital outcomes. Results: There were 117 (36.22%) RT-PCR positive patients with 36.53% confirmed, 13.00% probable and 50.46% suspect patients. For probable and confirmed patients, 25%, 21.25%, 23.13% 16.25% had no, mild, moderate, and severe symptoms, respectively with 14.28% critical cases. Over-all mortality rate for probable and confirmed cases was 25.54% with 91.3% mortality rate for critical cases. Co-morbidities with statistically significant association with severity of disease were as follows: hypertension, heart disease, cerebrovascular disease, diabetes mellitus and COPD. Conclusion During the early period of the COVID-19 pandemic, only 36.53% of cases admitted at our institution were COVID-19 confirmed by RT-PCR. One-third of the cases were severe and critical, with more clinical instability, increased inflammatory markers, and higher in-hospital morbidity and mortality.
COVID-19 ; Pandemics ; Philippines