J Korean Med Sci.  2007 Oct;22(5):846-850. 10.3346/jkms.2007.22.5.846.

Successful Surgical Treatment of Aortoenteric Fistula

• Kim JY
• Kim YW
• Kim CJ
• Lim HI
• Kim DI
• Huh S

• KMID: 1713291
• DOI: http://doi.org/10.3346/jkms.2007.22.5.846

Abstract

In order to establish optimal management for aortoenteric fistula (AEF) the records of five patients treated for AEF (four aortoduodenal and one aortogastric fistula) were retrospectively reviewed. The arterial reconstruction procedures were selected according to the surgical findings, underlying cause, and patient status. In situ aortic reconstructions with prosthetic grafts were performed on three patients who had no gross findings of periaortic infection, whereas axillo-bifemoral bypass was carried out in the other two patients with periaortic purulence. In all patients, after retroperitoneal irrigation a pedicled omentum was used to cover the aortic graft or aortic stump. In the preoperative abdominal computed tomography (CT) scan there was a periaortic air shadow in four out of five patients. There was no surgical mortality or graft infection observed during a mean follow-up period of 40 months (range, 24-68 months). Therefore, the treatment results of an AEF can be improved using intravenous contrast-enhanced abdominal CT for rapid diagnosis and selection of an appropriate surgical procedure based on the surgical findings and underlying cause.

Keyword

Aorta; Intestinal Fistula; Aortic Aneurysm

MeSH Terms

Aged
Aorta, Abdominal/*pathology
Aortic Aneurysm/surgery
Aortic Diseases/*surgery
Contrast Media/pharmacology
Fistula/*surgery
Humans
Intestinal Fistula/*surgery
Male
Middle Aged
Retrospective Studies
Time Factors
Tomography, X-Ray Computed/methods
Treatment Outcome

Figure

• 

  Fig. 1 Preoperative contrast-enhanced abdominal CT scans in a patient with an aortoenteric fistula (AEF); four out of five patients showed periaortic air shadows (arrows).

• 

  Fig. 2 (A) Preoperative CT scan in a patient with an aortogastric fistula shows a type IV thoracoabdominal aortic aneurysm and a markedly distended stomach. (B) Postoperative upper GI series with gastrografin shows a gastropleural fistula (GPF, arrow) in the same patient.

Reference

1. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg. 2005. 92:143–152.

2. Bacourt F, Koskas F. Axillobifemoral bypass and aortic exclusion for vascular septic lesions: a multicenter retrospective study of 98 cases. French University association for Research in Surgery. Ann Vasc Surg. 1992. 6:119–126.

3. Bandyk DF, Novotney ML, Johnson BL, Back MR, Roth SR. Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res. 2001. 95:44–49.

4. Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg. 1997. 25:255–266.

5. Kieffer E, Gomes D, Chiche L, Fleron MH, Koskas F, Bahnini A. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004. 39:1009–1017.

6. Leseche G, Castier Y, Petit MD, Bertrand P, Kitzis M, Mussot S, Besnard M, Cerceau O. Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg. 2001. 34:616–622.

7. Santilli SM, Goldstone J. Yao JST, Pearce WH, editors. Aortoenteric fistula. Arterial surgery. Management of Challenging Problems. 1996. Stanford, CO: Appleton & Lange;209–219.

8. Capaldo GR, Amin RM. Aortoduodenal fistula. Two case reports and a review of the literature. J Cardiovasc Surg Torino. 1996. 37:567–570.

9. Tareen AH, Schroeder TV. Primary aortoenteric fistula: two new case reports and a review of 44 previously reported cases. Eur J Vasc Endovasc Surg. 1996. 12:5–10.

10. Mark AS, Moss AA, McCarthy S, McCowin M. CT of aortoenteric fistulas. Invest Radiol. 1985. 20:272–275.

11. Low RN, Wall SD, Jeffrey RB Jr, Sollitto RA, Reilly LM, Tierney LM Jr. Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology. 1990. 175:157–162.

12. Jacobs MJ, Reul GJ, Gregoric I, Cooley DA. In-situ replacement and extra-anatomic bypass for the treatment of infected abdominal aortic grafts. Eur J Vasc Surg. 1991. 5:83–86.