[Aorto-enteric fistula as a cause of massive gastrointestinal hemorrhage]

The authors describe a rare complication following femoral reconstruction operations, i.e. an aorto-enteral fistula associated with massive gastrointestinal haemorrhage. They draw attention to limited diagnostic possibilities and sometimes the necessity to perform urgent laparotomy. The diagnosis is facilitated by endoscopy, CT, sonography and aortography. Endoscopy can determine the site of haemorrhage, not its cause. At present when there is a high number of vascular reconstruction operations, this possibility should be taken into account. The authors recommend to prevent this complication by inserting a transplant from the omentum between the intestinal wall and the prosthesis, or possibly to cover the wound by preaortal adipose and lymphatic tissue and to stitch the peritoneum to prevent direct contact. To resolve complications direct stitch may be used, a patch. More frequently it is, however, necessary to exchange the entire prosthesis and sometimes to ensure nurture by an extra-anatomical bypass. In urgent situations clamping of the aorta may be of temporary assistance.