[Aortoenteric fistulae. Diagnosis, therapy, results]

A series of 26 aortoenteric fistulas, 8 primary (PAEF) communications between abdominal aorta and gastrointestinal tract and 18 secondary (SAEF) communications between aortic graft and intestine, is reported. PAEF is commonly due to aneurysmal rupture into the intestine, while SAEF is an uncommon complication of abdominal aortic reconstructive surgery. Male to female ratio was 3:1 among the PAEF group and 8:1 among the SAEF one. Seven of the PAEF subjects underwent urgent surgical operation: 6 enteral defect closure and prosthetic aortic replacement. One patient underwent ileal resection and hypogastric artery ligation. Survival rate in this group was 42% (3/7). Among the 18 subjects affected with SAEF after intestinal repair, vascular procedures were 8 aortic graft removal and extra-anatomic bypass grafting, 4 aortic graft removal and aortic stump ligation, 5 anastomotic repairs and 1 prosthetic branch substitution. Survival rate among this group was 39% (7/18). No differences in outcome were noted in this series depending on type of operation, according to the literature. The authors conclude that surgical outcome is affected by the presence of severe infection not dominated by antibiotics rather than by surgical technique. In this series survival rate among the patients with negative bacterial culture of the surgical specimen raised up to 80%, while it decreased to 20% among subjects harboring septic retroperitoneal collection and graft infection.