Saers S J F, Scheltinga M R M
Department of Surgery, Máxima Medical Centre Veldhoven, de Run 4600, 5500 MB Veldhoven, The Netherlands.
Br J Surg. 2005 Feb;92(2):143-52. doi: 10.1002/bjs.4928.
A primary aortoenteric fistula (PAEF) is a rare clinical entity that results in fatal exsanguination if undiagnosed. The present study investigates whether management and survival have altered over time.
A Medline search was conducted for the period from January 1994 to December 2003. Data were categorized and compared with reviews of PAEF published before this interval.
The classical triad (gastrointestinal bleeding, pain and a pulsating mass) was present in only 11 per cent of 81 patients. Most PAEFs were caused by an aneurysmal aorta and were almost always (94 per cent) heralded by repetitive gastrointestinal bleeds. Computed tomography (CT) provides images superior to those of other diagnostic modalities, such as gastroduodenoscopy or conventional angiography. Operative mortality rates were lower in later years possibly owing to improvements in perioperative care and the advent of endovascular techniques.
Gastrointestinal bleeding combined with a negative endoscopy in the presence of an aneurysmal aorta suggests PAEF and requires urgent evaluation by CT. Endovascular operation is an attractive treatment option.
原发性主动脉肠瘘（PAEF）是一种罕见的临床病症，若未被诊断出来会导致致命性出血。本研究调查了其治疗方法和生存率是否随时间发生了变化。
对1994年1月至2003年12月期间进行了医学文献检索。对数据进行分类，并与该时间段之前发表的PAEF综述进行比较。
81例患者中只有11%出现了典型三联征（胃肠道出血、疼痛和搏动性肿块）。大多数PAEF由主动脉瘤引起，几乎总是（94%）以反复胃肠道出血为先兆。计算机断层扫描（CT）提供的图像优于其他诊断方式，如胃十二指肠镜检查或传统血管造影。近年来手术死亡率较低，这可能归因于围手术期护理的改善和血管内技术的出现。
在存在主动脉瘤的情况下，胃肠道出血且内镜检查结果为阴性提示PAEF，需要通过CT进行紧急评估。血管内手术是一种有吸引力的治疗选择。
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