Primary aortoenteric fistula: Report of two cases

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.