PRIMARY AORTOENTERIC FISTULA - REPORT OF 8 NEW CASES AND REVIEW OF THE LITERATURE

Primary aortoenteric fistula, a direct communication between the aorta and the intestinal tract, is a rare cause of gastrointestinal hemorrh age. Eight patients who were all treated at one hospital are described , followed by a review of all surgically treated patients reported wit hin the past 10 years. The usual cause is erosion of an atheroscleroti c aneurysm into the adherent duodenum, but a wide variety of other cau ses and localizations have been described. The clinical presentation i s usually one of intermittent gastrointestinal hemorrhage resulting in lethal exsanguination within a matter of hours or days. Pain, a pulsa tile abdominal mass, or fever may or may not be present. Endoscopy, ar teriography, ultrasound, and CT scan can be useful in the evaluation o f these patients, but physical examination and a high index of suspici on remain key to diagnosis. Primary aortoenteric fistula is more often discovered unexpectedly during exploratory laparotomy and is not usua lly considered as a presumptive preoperative diagnosis. Although conta mination is unavoidable, most patients are treated with an in situ vas cular graft and primary closure of the intestinal defect with good res ults.