Aortoenteric fistulas

Arch Surg. 1992 Oct;127(10):1191-3; discussion 1193-4. doi: 10.1001/archsurg.1992.01420100049008.

Abstract

During an 11-year period ending in December 1991, 36 patients with aortoenteric fistulas were assessed and treated. Twenty-five patients (69%) had previously undergone aortic reconstruction with Dacron grafts, and 11 (31%) had spontaneous aortoenteric fistulas. Of the 25 patients with secondary fistulas, 14 (56%) had undergone aortic aneurysmal rupture or multiple aortic vascular reconstructions. Preoperative diagnosis was established in only 13 (36%) of 36 patients. Remote bypass preceding removal of the infected arterial prosthesis had the least morbidity and mortality. Three primary fistulas were found in unusual locations: aortocolonic, aortobronchial, and aortoesophageal. The patient with the aortoesophageal fistulas was the fifth survivor described in the literature. The overall mortality was 56%. A positive preoperative blood culture predicted a poor outcome. There were four amputations, there due to infection of the extra-anatomical bypass. Prompt directed assessment to ensure appropriately staged operative intervention should improve survival.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / surgery
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Diseases / physiopathology
  • Aortic Diseases / surgery*
  • Aortic Rupture / complications
  • Bacteremia / etiology
  • Blood Vessel Prosthesis
  • Duodenal Diseases / physiopathology
  • Duodenal Diseases / surgery*
  • Female
  • Fistula / physiopathology
  • Fistula / surgery*
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / physiopathology
  • Humans
  • Intestinal Fistula / physiopathology
  • Intestinal Fistula / surgery*
  • Male
  • Middle Aged
  • Polyethylene Terephthalates
  • Postoperative Complications
  • Retrospective Studies
  • Surgical Wound Infection / etiology

Substances

  • Polyethylene Terephthalates