The authors report a series of 10 patients who presented with 4 primary aorto-enteric fistulas (AEFs) and 8 secondary AEFs. Gastrointestinal bleeding is the main feature of this serious complication. The diagnosis is difficult; no single procedure: endoscopy, angiography, CAT scan, or upper gastrointestinal film series is regularly diagnostic for AEF. Acute massive exsanguination needs urgent explorative xyphopubic midline laparotomy without preoperative work- up. The surgical treatment consists of endoaneurysmorraphy or graft prosthesis resection without "in situ" vascular reconstruction. The extraanatomic bypass permits the revascularization of the lower limbs. In this series, the prognosis appeared to be poor. The mortality rate with primary AEF was 50%, and the morbidity consisted, after "in situ" reconstruction, of early or late secondary AEF. In secondary AEF, the mortality rate after extraanatomic reconstruction with graft excision was 62%. The main complications were infection, fistuliza tion, and hemorrhage.
Get full access to this article
View all access options for this article.
References
1.
Ackroyd J., Williams T., Thomas M., Burnand R.: The diagnosis of aortograft-enteric fistulae by computed tomography . Brit J Surg72:72-73, 1985.
Banai I., Salfay G., Szeleczky M., Kun M.: An uncommon endoscopic finding: bleeding secondary aortoenteric fistula . Endoscopy14:185-186, 1982.
4.
Bussutil RW, Rees PW, Baker JD, Wilson SE: Pathogenesis of aorto-duodenal fistula: experimental and clinical correlates . Surg85:1, 1979.
5.
Champion MC, Sullivan SN, Coles JC, Goldbach M., Watson WC: Aorto-enteric fistula: Incidence, presentation, recognition and management . Ann Surg195:314, 1982.
6.
Connoly JE, Kwaan JH, McCart PM, Brownell DA, Levine EF: Aorto-enteric fistula. Ann Surg194:402, 1981.
7.
DeVos M., Huble F., Elewaut A., Barbier F.: Fistule aorto-duodénale. Role de l'endoscopie. Acta Endos14:103-108, 1984.
8.
Eger M., Hirsch M., Junod JM: Un cas rare de fistule aorto-digestive: double communication entre l'aorte, l'artère iliaque primitive et le jejunum. Ann Chir Thorac Card8:1001, 1969.
9.
Elliot JP, Smith RF, Szilguyi DE: Aorto enteric and paraprosthetic enteric fistulas. Problems of diagnosis and management. Arch Surg108:479, 1974.
10.
Glock Y., Bouissou E., Tasrini J., Fourtanier G., Fournier D., Puel P.: Fistules aorto-enteriques et para prothetiques: a propos de 5 cas . J Chirg 121:347-353, 1984.
11.
Glock Y., Buissou E., Fourtanier G., Puel P.: Fistules aorto-enteriques et paraprothetiques. Mise au point. NouvRev MedToulouse3:105-111, 1984.
12.
Glock Y., Benallou A., Puel P.: Les pontages extra-anatomiques destinés aux membres inferieurs. A propos d'une serie de 51 cas consecutifs. J Chirg 121:593-598, 1984.
Kleinman LH , Towne JB, Bernhard VM: A diagnostic and therapeutic approach to aorto-enteric fistulas. Clinical experience with 20 patients. Surg36:868, 1979.
15.
Knight C., Farnell M., Hollier L.: Treatment of aortic graft infection with povidone-iodine irrigation . Mayo Clin Proc58:472-475, 1983.
16.
O'Mara C., Williams GM, Ernst C.: Secondary aorto-enteric fistula. Am J Surg142:203, 1981.
17.
Perdue G., Smith R., Ansley J., Constantino M.: Impending aorto-enteric hemorrage: the effect of early recognition on improved outcome. Ann Surg192:237, 1980.
18.
Pfeiffer RB : Successful repair of three primary aortoduodenal fistulae. Arch Surg117:1098, 1982.
19.
Puppala AR, Munaswamy M., Doshi A.: Endoscopic diagnostic of aortoduodenal fistula. Am J Gastroenterol73:414-417, 1980.
Rosenthal D. , Deterling RA, O'Donnell TF, Callow AD: Positive blood culture as an aid in the diagnosis of secondary aorto-enteric fistula. Arch Surg114:1041-1044, 1979 .
22.
Sweeney M., Gadacz T.: Primary aortoduodenal fistula: manifestation, diagnostic and treatment . Surg93:492-497, 1984.
23.
Trout HH, Kozloff L., Giordano J.: Priority of revascularization in patients with graft enteric fistulas, infected arteries or infected arterial prostheses. Ann Surg199:669, 1984.
24.
Williams M. , Dixon A.: Aortic graft abcess with duodenal communication . J Comput Assist Tomo7:916, 1983.
25.
Wilson SE, Bennion RS, Serota AI, Williams RA: Bacteriological implications in the pathogenesis of secondary aorto-enteric fistulas. Br J Surg69:545, 1982.
