AORTOENTERIC FISTULA PROBABLY CAUSING AN ENDOSCOPICALLY UNCLEAR GASTROINTESTINAL-BLEEDING

Primary aorto-enteric fistulae are rare, mostly described as atypical first manifestation of an abdominal aortic aneurysm. Spread of electiv e aortic surgery led to increased appearance of secondary aorto-enteri c fistulae as a typical postoperative complication. Gastrointestinal b leeding with endoscopical unclear findings in a patient with aortic an eurysm or history of aortic repair points towards an aorto-enteric fis tula. While preoperative diagnosis is not possible in most instances, the proof of an anastomotic aneurysm and/or aortic graft infection har dens the suspected diagnosis of an aorto-enteric fistula decesively. T he finding of coincidential mucosal lesions at gastroscopy may not mis lead to give up the exclusion of an aorto-enteric fistula, possibly by explorative laparotomy, if suspicion is well-founded. In the present article nine cases of aorto-enteric fistulae treated at the Surgical U niversity Clinic Wurzburg between 1982 and 1993 are analyzed retrospec tively. Topical questions of diagnosis and therapy are discussed.