Aortoenteric fistulas - our experiences with surgeons' nightmare

Abstract

BACKGROUND: Aortoenteric fistula (AEF) is a rare medical emergency, but one of the most difficult and threatening complications of gastrointestinal (GI) bleeding. METHODS: A retrospective observational study was performed on patients hospitalised with GI bleeding and a definitive AEF diagnosis. We collected operative reports and medical records of patients operated on with an AEF diagnosis. The literature data and our data were analysed and discussed. RESULTS: We admitted eight patients who were definitively diagnosed with AEF after reviewing our hospital records. All patients were male except one. Their ages ranged from 28 to 82, with a mean of 64. All but two patients had secondary AEF (SAEF). Four SAEF cases had open aortic surgery and three had a history of endovascular procedure. The main complaints of the patients on admission were poor general condition, abdominal pain, and GI bleeding. Melena was found in all patients. Hematemesis and hematochezia were other significant GI bleeding findings. Infected grafts were removed in all but one patient; extra-anatomical bypass surgery and bowel repairs were performed. One patient underwent endovascular repair. In all patients, the 30-day in-hospital mortality rate was 50%. CONCLUSION: In patients presenting with GI bleeding, an aortoenteric fistula should be considered. The outcome depends on early diagnosis, the patient's medical status, the severity of infection, and the anatomic location of the affected aorta. A multidisciplinary approach, appropriate treatment planning and close follow-up after treatment lead to positive outcomes.