Primary aortoenteric fistulas

• Published in: The American surgeon Vol. 58; no. 1; p. 53
• Main Authors: Wheeler, W E, Hanks, J, Raman, V K
• Format: Journal Article
• Language: English
• Published: United States 01.01.1992
• Subjects: Aged; Aorta, Abdominal - surgery; Aortic Aneurysm - complications; Aortic Aneurysm - surgery; Aortic Diseases - etiology; Aortic Diseases - surgery; Duodenal Diseases - etiology; Duodenal Diseases - surgery; Duodenum - surgery; Fistula - etiology; Fistula - surgery; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - surgery; Humans; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Male; Middle Aged
• ISSN: 0003-1348

Aortoenteric fistulas were first reported in 1822. Primary aortoenteric fistulas are uncommon (less than 200 cases reported). Secondary aortoenteric fistulas are a well-recognized complication of prosthetic grafts (incidence from 0.4 to 2.4%). Atherosclerosis, gallstones, foreign bodies, carcinomas, and diverticular disease are the most common etiologies. Diagnosis is difficult with most studies being nondiagnostic. A high incidence of suspicion is required to successfully diagnosis preoperatively. Surgical repair is required for survival of the patients and should consist of the following: 1) primary closure of the intestinal defect, 2) either primary anatomical repair with a prosthetic graft or extra-anatomical vascular reconstruction, depending upon the presence or absence of infection, and 3) treatment with appropriate antibiotics. One of the largest series of primary aortoenteric fistulas from a single institution consisting of three cases secondary to aneurysmal and granulomatous disease is discussed.