Aorto-Enteric Fistulas

Abstract

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.