[Aorto-enteric fistulas. Report of 12 cases]

Aorto-enteric fistulae are primary or secondary. The primary variant is the rupture of an aortic aneurysm into the gastro-intestinal tract. The secondary fistulae are complications of reconstructive aortic surgery. We report our experience with 12 aorto-enteric fistulae (2 primary and 10 secondary) treated from 1971 to 1989. All patients presented with gastro-intestinal bleeding and the fistula was to the duodenum (3), jejunum (8) or appendix (1). In the secondary patients, a mean of 5 years had elapsed since the aortic replacement. In addition to closure of the enteric defect, three types of treatment were applied: excision of the old prosthesis, infrarenal aortic closure and axillo-bifemoral bypass (5); insertion of a new graft (3) and local repair (3). A patient was not treated due to a triple carcinoma. Hospital mortality was 50%. We conclude that the diagnosis of aortoenteric fistula is difficult and that the mortality is high. The operative management remains imperfect and a subject of controversy. Prevention and early detection request more attention than in the past.