Aortoenteric fistula: a mandatory early operative diagnosis.

The records of eight patients with aortoenteric fistulas from 1961 to 1976 were reviewed. The aortoenteric fistulas were primary in three patients and secondary in the remaining five. The most common symptom was gastrointestinal hemmorrhage, seen in seven of eight patients. Four patients also had fever. Seventy percent of patients survived more than 24 hours after the initial hemorrhage, allowing time for a rapid work-up. An algorithm is presented for evaluating a patient suspected of having an aortoenteric fistula. It is a work-up of exclusion and requires six to eight hours. The definitive diagnosis and management of the patient is accomplished by surgical exploration. Primary aortoenteric fistulas are best managed by aneurysmectomy and Dacron graft replacement. Management of secondary fistulas should be tailored to the condition of the patient at the time of operation. The preferred treatment consists of excision of the graft and extra-anatomic bypass. The operative mortality in this series was 25%.