Primary aortoenteric fistula

A primary aortoenteric fistula (PAEF) is a rare clinical entity that results in fatal exsanguination if undiagnosed. The present study investigates whether management and survival have altered over time.

A Medline search was conducted for the period from January 1994 to December 2003. Data were categorized and compared with reviews of PAEF published before this interval.

The classical triad (gastrointestinal bleeding, pain and a pulsating mass) was present in only 11 per cent of 81 patients. Most PAEFs were caused by an aneurysmal aorta and were almost always (94 per cent) heralded by repetitive gastrointestinal bleeds. Computed tomography (CT) provides images superior to those of other diagnostic modalities, such as gastroduodenoscopy or conventional angiography. Operative mortality rates were lower in later years possibly owing to improvements in perioperative care and the advent of endovascular techniques.

Gastrointestinal bleeding combined with a negative endoscopy in the presence of an aneurysmal aorta suggests PAEF and requires urgent evaluation by CT. Endovascular operation is an attractive treatment option.