van Olffen T B M, Knippenberg L H A, van der Vliet J A, Lastdrager W B
Department of Surgery, Lokatie Lucas, Apeldoorn, Albert Schweitzerlaan 31, Apeldoorn, Netherlands.
Cardiovasc Surg. 2002 Dec;10(6):551-4. doi: 10.1016/s0967-2109(02)00104-7.
Primary aortoenteric fistula (PAEF) is defined as a communication between the native aorta and the gastrointestinal tract, in contrast to secondary fistulas, which arise between a suture line of a vascular graft and the intestine. Arteriosclerosis is the predominant cause of PAEF and accounts for more than two-thirds of the cases reported. The pathogenesis is usually based on direct adhesion of a segment of the gastrointestinal tract to an aortic aneurysm, followed by progressive erosion through the bowel wall. The clinical presentation is usually one of intermittent gastrointestinal haemorrhage resulting in lethal exsanguination. Pain in the abdomen, a pulsatile abdominal mass or fever may be present. The choice of various diagnostic procedures is often decided by the clinical presentation. Esophagogastroduodenoscopy, ultrasound and CT scan may be useful in the evaluation of these patients. Current recommendations for repair include debridement of the aneurysmal aorta, repair with an in situ graft and primary repair of the gastrointestinal tract, followed by aggressive antimicrobial therapy. We present six cases of PAEF surgically treated at the St. Radboud Hospital, the Canisius Wilhelmina Hospital in Nijmegen and the Lukas Hospital in Apeldoorn over a period of 15 years.
原发性主动脉肠瘘（PAEF）被定义为天然主动脉与胃肠道之间的相通，与之相对的是继发性瘘，后者发生在血管移植物的缝合线与肠道之间。动脉硬化是PAEF的主要病因，占报告病例的三分之二以上。其发病机制通常是一段胃肠道直接粘连至主动脉瘤，随后逐渐侵蚀肠壁。临床表现通常为间歇性胃肠道出血，可导致致命性失血。可能会出现腹痛、腹部搏动性肿块或发热。各种诊断程序的选择通常由临床表现决定。食管胃十二指肠镜检查、超声和CT扫描可能有助于评估这些患者。目前的修复建议包括对动脉瘤性主动脉进行清创、用原位移植物修复以及对胃肠道进行一期修复，随后进行积极的抗菌治疗。我们介绍了在15年期间于奈梅亨的圣拉德布德医院、卡尼修斯威廉明娜医院和阿珀尔多伦的卢卡斯医院接受手术治疗的6例PAEF病例。
