[Aorto-digestive fistula and aortic prosthesis. Report of four cases]

The diagnosis of gastrointestinal bleeding secondary to aortoduodenal fistula and the decision to proceed to an early diagnostic and/or therapeutic laparotomy are often difficult in practice. We report 4 cases of patients with aortic prostheses who were hospitalized for gastrointestinal bleeding secondary to aortoduodenal fistula. All of them presented initially with lightheadedness before evidence of GI bleeding. Emergency esophagogastroduodenoscopy performed for 3 patients was normal for 2 of them and showed an ulcer with a stitch at its center in the third duodenum for the other. Abdominal CT scan performed for all the patients confirmed the diagnosis for only one case. Of the 3 patients with a normal CT scan, 2 underwent angiography which provided the diagnosis of aortoenteric fistula successfully treated by embolization. The other angiogram was normal. Surgery was required to establish the diagnosis in one patient and diagnosis was post mortem for the last one.