Aorto-intestinal fistula as a possible cause of endoscopically undetermined gastrointestinal hemorrhage

Primary aorto-enteric fistulae are rare, mostly described as atypical first manifestation of an abdominal aortic aneurysm. Spread of elective aortic surgery led to increased appearance of secondary aorto-enteric fistulae as a typical postoperative complication. Gastrointestinal bleeding with endoscopical unclear findings in a patient with aortic aneurysm or history of aortic repair points towards an aorto-enteric fistula. While preoperative diagnosis is not possible in most instances, the proof of an anastomotic aneurysm and/or aortic graft infection hardens the suspected diagnosis of an aorto-enteric fistula decisively. The finding of coincidental mucosal lesions at gastroscopy may not mislead 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 University Clinic Würzburg between 1982 and 1993 are analyzed retrospectively. Topical questions of diagnosis and therapy are discussed.