Aortoenteric Fistula

Abstract

Because of the unacceptably high mortality rate associated with aortoenteric fistula, we have constantly re-evaluated our experience with this lesion. A study of 31 cases of aortoenteric fistula proven at operation has provided a better understanding of the prevention and management of aortoenteric fistula. Prevention remains the primary goal, as the treatment of this complication even with the adoption of recommendations made in our paper can be expected to continue to carry a significant late mortality rate. The most important point in prevention is to provide adequate protection between gut and graft, using tissue, prosthetic cuff and correct reperitonealization techniques. Systemic or groin infection should be followed by prompt total removal of the graft before the onset of aortoenteric fistula. Once aortoenteric fistula is present, early operation with removal of the graft, proper closure of the aortic and enteric openings, and sump drainage of the area is indicated. Blood supply to the extremities is supplied by extra-anatomic bypass or endarterectomy if the underlying problem is arterial occlusive disease. Paraprosthetic aortoenteric fistulas may be diagnosed early by the presence of fever, blood culture, and a high degree of suspicion. CAT and gallium 67 scanning can be helpful in identifying this early type of fistula.

An Iatrogenic Sigmoid Perforation Caused by an Aortobifemoral Graft Mimicking an Advanced Colon Cancer

“…Secondary AEF usually occur some years after aortic reconstructive surgery, although they can present anywhere from six months to more than 10 years postoperatively (12). They are thought to be associated with chronic low-grade infection of and around the graft, possibly secondary to suture line failure (6,13).…”

“…AEF most commonly involve the third or fourth portion of the duodenum (87% of cases) and more rarely the jejunum (7%), ileum (4%) or colon (2%) (1, 14) because they are relatively fixed (6).…”

“…The third or fourth portion of the duodenum is the most common site for AEF development, while the colon is involved only rarely (6). AEF are potentially catastrophic causes of GI bleeding that are easy to miss if not considered in the differential diagnosis.…”

Secondary aortoduodenal fistula

“…ADF are the most frequent aor to-enteric fistulae (80%) [1] . They may be primary due to a spontaneous communication between the lumen of aortic aneurysm…”

“…The third or fourth duodenal segment is the most frequently involved site. In Dacron prosthesis patients, fistula develops in the proximal graft tract opening in the third segment of the duodenum [1] . The right diagnosis of ADF can be difficult.…”