Abstract
The authors report 2 cases of primary aortoenteric fistula and discuss a number of
interesting features demonstrated by them. The first patient, a fifty-six-year-old
woman, underwent a right hemicolectomy for carcinoma in 1986 and presented three years
later with massive hematemesis and hematochezia. At emergency laparotomy a fistulous
communication was found between the fourth portion of the duodenum and the aorta caused
by carcinomatous retroperitoneal nodes. A Dacron tube graft was placed in the aorta,
and the duodenum was repaired with limited resection and end-to-end anastomosis. The
patient recovered well, but she died on the thirtieth postoperative day in profound
hypovolemic shock. The second case, a sixty-seven-year-old man, presented with an
abdominal pulsatile mass and a forty-eight-hour history of abdominal pain, weakness,
and melena. Ultrasonic and computed tomographic examination indicated a small infrarenal
aortic aneurysm communicating with the bowel. At laparotomy a fistulus tract was found
between the aneurysm and the jejunum. The aneurysm was replaced by a Dacron tube graft
and the jejunum was repaired with resection and end-to-end anastomosis. Recovery was
uneventful and the patient remains well fifteen months later.
