Secondary aortoenteric fistula: 3 case reports and review

Secondary aortoenteric fistula is a rare but well-known delayed and life-threatening complication of previous aortic reconstruction which is as difficult to diagnose as it is to treat. A combination of esophagogastroduodenoscopy and computed tomography (CT) or MR may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion in patients who have undergone aortic surgery and present classically with either signs of infection or gastrointestinal hemorrhage.

The authors report 3 cases of aortoenteric fistulas presenting during 10 months to the 3rd Dept. of Internal Medicine and discuss the modern management of this challenging complication of aortic surgery. The individual patients had a mean age of 63 years at time of complication, mean time from primary operation to fistulation was 9 years, the time from the first symptoms to diagnosis varied between hours and two months. In all of our cases the involved bowel segment was the third portion of the duodenum and all patients were reoperated successfully.

Because of the increasing number of elective aortic aneurism repairs in the aging population, more patients will present to our practice, therefore the authors emphasize the importance of this uncommon cause of obscure GI bleeding.