Aorto-Enteric Fistula

R. Brooke Jeffrey, MD

Key Facts

Terminology

Abnormal communication between aorta and gastrointestinal tract

Imaging

Best diagnostic clue: Inflammatory stranding and gas between abdominal aorta and 3rd part of duodenum following aneurysm repair
Location: Duodenum (80%); jejunum and ileum (10-15%); stomach and colon (5%)
Best imaging tool: CT 94% sensitive, 85% specific

Top Differential Diagnoses

Periaortitis
Retroperitoneal fibrosis
Postoperative changes
Postendovascular stent

Pathology

Primary etiology: Abdominal aortic aneurysms, infectious aortitis, penetrating peptic ulcer, tumor invasion, radiation therapy
Secondary etiology: Aortic reconstructive surgery most common

Clinical Issues

Very poor prognosis, up to 85% mortality
Percutaneous drainage of infected perigraft fluid may be initial treatment, followed by surgery
“Herald” GI bleeding, followed hours/days/weeks later by catastrophic hemorrhage

Diagnostic Checklist

Perigraft infection evidenced by ectopic gas or perigraft soft tissue raises suspicion of fistula

(Left) Graphic shows a fistula between the transverse duodenum & aorta

at the site of the graft-aortic suture line

. (Right) Axial CECT in a 70-year-old man presenting with fever and hematemesis months after abdominal aortic aneurysm repair shows the native, calcified aortic wall