Two patients with late graft enteric fistula (GEF) are reported, one at nineteen years (238 months) and the other at nineteen years eleven months after implan tation. In a review of the literature the incidence varies from 0.2% to 4% and also varies for emergent, elective, aneurysmal, and occlusive disease. Mechani cal and infectious factors, alone or in combination, are thought to comprise the etiology of GEF. The diagnosis is based on a high index of suspicion and must be considered in any patient with a previous aortic graft and gastrointestinal bleed ing until proved otherwise. No single diagnostic study is useful in all cases, and exploratory laparotomy may be the final diagnostic procedure in some. Most authors recommend total graft excision and extra-anatomic bypass; however, in situ repair or replacement has been performed in a few selected cases. The 2 cases reported demonstrate that there is no time limit for occurrence of GEF after abdominal aortic reconstruction.
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