aortoenteric fistula: fear it

13 Oct


Aortoenteric fistula: a communication between the aorta and the GI tract

consider in anyone with a GI bleed and a history of aortic surgery.

Can involve any part of the bowel but 75% involve the third part of the duodenum.

Mean time to presentation from surgical date is 32 months, but can run the gamut.


Can be primary (from AAA, but this is rare), but often related to aortic graft


Herald Bleeds

  • often have self-limited “herald bleeds”, can be intermittent
  • Stops from vasospasm or thrombus formation
  • Followed by massive GI bleed over the next month; 30% of these are within next 6 hours



  • Conventional CT
  • CTA (most sensitive with “detection rate” of 61%)
  • EGD (25-62.5% or primary fistulas are identified)
  • Laparotomy



  • Endovascular stent for those than cannot tolerate surgery
  • Graft resection, repair of duodenal wall, and new bypass (mortality rate: 30-40%)
  • Gentle resuscitation: SBP goal 60-100
  • Survival rates with treatment: 30-70%


References:  MacDougall, L et al. Aorto-enteric fistulas: a cause of gastrointestinal bleeding not to be missed.  BJMP. 2010; 3(2): 317.   Ranasinghe, W et al. Primary aortoenteric fistulae: the challenges in diagnosis and review of treatment. Ann Vasc Surg. 2011; 25(3): 386; picture


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: