[Aorto-enteral fistulae: clinical course, diagnosis and management]

Aorto-enteric fistula (AEF) is a very rare entity. Any direct or indirect communication between the arterial tree and the intestine represents a life threatening situation. Major symptom is gastro-intestinal bleeding with varying longevity and gravity. Preoperative diagnosis is difficult and this is why higher level of suspicion is necessary. Presence of Abdominal Aortic Aneurysm (AAA) or aorto-iliac grafts makes the diagnosis more likely. AEF are: primary, predominantly a complication of ruptured AAA, and secondary, after aorto-iliac reconstruction. The most frequent location of AEF is the end part of tue duodenum. In the group of secundary AEF the paraprosthetic type represents the most frequent morphological findings. Preoperative confirmation of an AEF however proved difficult despite the improvement in endoscopic and imaging technology. Diagnostic modality of choice is enhanced computed tomography. Management is surgical only. The choice of surgical repair is still controversial. Every effort must be made to prevent its occurrence by separating bowel and artery at the first aortic operation. Our experience in diagnosis and treatment of AEF is based on 3 cases with aorto-duodenal fistulas. Pathogenesis, clinical features and therapeutic aspects are presented and discussed.