[Diagnosis of secondary aortointestinal fistulae]

Abstract

A secondary aortoenteric fistula (SAIF) is a direct communication between the gastrointestinal (GI) tract and the aorta in a patient who has undergone major surgery on the aorta, often an aortic graft operation. The cardinal symptoms of a SAIF are septicaemia and/or GI-haemorrhage. In this case, a 40 year old man was admitted to the hospital because of repeated episodes of fever, chills and malaise. The patient had undergone an aortofemoral by-pass graft operation five years previously. Blood cultures showed repeated growth of different enteric-related microorganisms. None of the used diagnostic investigations revealed any signs of infection or fistulation near the aortic graft. After five months of hospitalization an endoscopy revealed the aortic graft protuding into the duodenal lumen, verifying the fistula. If GI-haemorrhage and/or septicaemia arise in a patient who has undergone major surgery on the aorta, one must suspect a secondary aortoenteric fistula and not hesitate too long to perform an explorative laporatomy. If untreated, the mortality rate of the condition is 100%.