Lessons from Successful Surgical Treatment of Aortoenteric Fistula

ABSTRACT

Aorto-enteric fistula (AEF) is a rare cause of gastrointestinal (GI) bleeding but has a high mortality rate. PURPOSE: To find a better way to manage this rare vascular condition, we reviewed our series of surgical treatment for AEF. METHOD: We retrospectively reviewed the medical records of 5 patients with AEF. For the diagnosis of AEF, a contrast-enhanced abdominal CT scan was performed for all patients but conventional aortography was not performed. The surgical procedures for the AEF were determined by the operatvie findings. For 3 patients with no evidence of periaortic infection, enteric fistula closure and aortic aneurysm repair with prosthetic grafts were performed while the other 2 patients revealing periaortic infection underwent resection of infected aorta (or infected aortic graft), aortic suture closure, retroperitoneal coverage with omental pedicle and axillo-bifemoral bypass were performed. In a patient who underwent abdominal aortic resection, concomitant left colectomy was required due to colonic ischemia. RESULT: The underlying causes and features of AEF were 4 primary and 1 secondary AEF; 4 aorto-duodenal and 1 aorto-gastric fistula; 4 infrarenal and 1 type IV thoracoabdominal aneurysm, and 4 true and 1 paraanastomotic pseudoaneurysm. Episodes of herald bleeding and periaortic air bubble on CT scan was noted in 4/5 (80%) of patients. There was no operative mortality or graft infection during the follow up period (mean, 23 months, range 3~50 months). CONCLUSION: For the early diagnosis of AEF, periaortic air bubble shadow on abdominal CT scan in a patient with pulsating abdominal mass or previous history of aortic surgery was an important diagnostic clue. Prompt surgical treatment according to the operative finding resulted in good surgical outcomes.