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Aortoenteric fistula: Recognition and management

Luis R Leon, MD, RVT, FACS
Section Editors
Joseph L Mills, Sr, MD
John F Eidt, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Aortoenteric fistulae (AEFs), first described in the early 19th century by Sir Astley Cooper [1], are uncommon but life-threatening conditions. AEF is defined as an abnormal connection between the aorta and the gastrointestinal tract. It is most often the result of compression of an abdominal aortic aneurysm (AAA) against (primary cause), or erosion of an aortic prosthetic graft into (secondary cause) the surrounding gastrointestinal structures.

The clinical manifestations, diagnosis, and management of AEFs are reviewed here. The management of asymptomatic and general management of symptomatic abdominal aortic aneurysms are discussed separately. (See "Management of asymptomatic abdominal aortic aneurysm" and "Management of symptomatic (non-ruptured) and ruptured abdominal aortic aneurysm".)


Aortoenteric fistula (AEF) is an uncommon but life-threatening condition. AEF is defined as an abnormal connection between the aorta (or aortoiliac tree) and the gastrointestinal tract. It is most often the result of primary compression of the aorta (eg, abdominal aortic aneurysm) against, or erosion of an aortic prosthetic graft into the surrounding gastrointestinal structures. AEFs are most commonly a single communication between the aorta and a single organ, most often within the gastrointestinal tract. However, the aorta can fistulize to other organs concomitantly with the gastrointestinal tract, or to other organs independent of the gastrointestinal tract [2-4].

Two types of AEFs are recognized: primary aortoenteric fistula (PAEF) and secondary aortoenteric fistula (SAEF).

Primary aortoenteric fistula (PAEF) — Primary aortoenteric fistula (PAEF) arises de novo between the aorta and the bowel. One laboratory study of PAEF in dogs demonstrated a role for both mechanical factors and aortic inflammation/infection in their development [5]. However, some feel that aortic inflammation/infection plays the more important role [6]. Septic aortitis with transient bacteriemia, which may be due to a variety of pathogens [7-10], seeds bacteria onto the inner arterial surface and permits the formation of an aneurysm or false aneurysm that erodes into adjacent structures [11,12]. (See "Overview of infected (mycotic) arterial aneurysm", section on 'Etiology'.)


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