Aorto‐enteric Fistula

Abstract

Twelve aorto‐enteric fistulas are reviewed. The typical presentation is a patient with gastrointestinal bleeding (acute or chronic) and an abdominal aortic graft, often with symptoms of infection. Endoscopy and computed tomography are the most useful preoperative investigations. False aneurysms seen on aortography can be confused with normal suture line irregularity. A nipple projecting from the aneurysm is very suggestive of a fistula, while contrast extravasation is diagnostic, but rarely seen. Barium studies and ultrasound can be helpful.

Aortic Paraprosthetic-colonic Fistulae: A Review of the Literature

“…This assertion has not been universally confirmed. Although Armstrong et al 43 concurred with Elliott's observations (identifying as the indication for aortic reconstruction an aneurysm in 72% of their patients (21) with SAEFs, and aortoiliac occlusive disease in 28%). Vollmar and Kogel 22 found a higher incidence of SAEFs after reconstruction for occlusive disease (1.1% vs. 0.2% for aneurysms).…”

Detection of aortoenteric fistula with helical CT

“…The interval between aortic surgery and the onset of gastrointestinal bleeding can range from a few days to 14 years, the median interval being approxiamtely 3 years 1 . Bleeding is commonly intermittent with most patients having an initial episode (herald bleed) followed hours, days or weeks later by catastrophic haemorrhage 4 . Approximately 50% of patients have abdominal or back pain, and less than 50% have a fever 6,8 .…”

“…1 Bleeding is commonly intermittent with most patients having an initial episode (herald bleed) followed hours, days or weeks later by catastrophic haemorrhage. 4 Approximately 50% of patients have abdominal or back pain, and less than 50% have a fever. 6,8 Prompt diagnosis is critical with early surgical intervention being the key to successful management.…”

“…The interval between aortic reconstructive surgery and the onset of gastrointestinal haemorrhage is varied. Most patients present with an initial episode of bleeding (herald bleed) followed by catastrophic haemorrhage after a variable period of time 4 . Early diagnosis is mandatory in the management of this condition.…”