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[Aorto-enteric fistulas].

L B Davidovic1, D S Spasic, S I Lotina

  • 1Institute of Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade. lazard@eunet.yu

Srpski Arhiv Za Celokupno Lekarstvo
|January 19, 2002
PubMed
Summary
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Aorto-enteric fistula (AEF) is a rare but serious condition. This study presents 9 cases, highlighting diagnostic challenges and treatment outcomes for both primary and secondary AEFs.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Surgical Innovation

Context:

  • Aorto-enteric fistula (AEF) represents a direct communication between the aorta and the intestinal lumen, presenting in primary (aortic aneurysm erosion) and secondary (post-surgical) forms.
  • Both forms carry significant morbidity and mortality, necessitating effective diagnostic and therapeutic strategies.
  • The incidence of primary AEF is 0.1-0.8%, and secondary AEF is 0.4-2.4%, with mortality rates for secondary AEFs ranging from 14% to 70%.

Purpose:

  • To present 9 new cases of aorto-enteric fistula (AEF), analyzing their etiology, clinical manifestations, diagnostic approaches, and surgical management.
  • To review the existing literature on AEF, contributing to a better understanding of this rare but critical condition.
  • To evaluate the outcomes of surgical interventions for both primary and secondary AEFs.

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Summary:

  • A retrospective analysis of 9 male patients (average age 66.62) with AEFs (4 primary, 5 secondary) over 33 years revealed gastrointestinal bleeding as the dominant symptom.
  • Diagnosis was challenging, with intraoperative findings in most cases, while imaging modalities like gastrography, colonoscopy, and ultrasonography played a role in select instances.
  • Surgical management varied, including aneurysmal resection with bypass grafting for primary AEFs and aortic graft removal with omental wrapping for secondary AEFs, with high postoperative mortality (7/9 deaths).

Impact:

  • This case series underscores the high mortality associated with AEFs and the complexities in diagnosis and surgical repair.
  • The findings emphasize the need for prompt recognition and tailored surgical strategies to improve patient outcomes.
  • The study contributes to the limited literature on AEF, offering insights into management options and potential areas for future research, including suggested techniques like "Omega" bypass and intraoperative balloon occlusion.