Franke S, Debus E S, Voit R
Chirurgische Universitätsklinik Würzburg.
Chirurg. 1995 Feb;66(2):112-9.
Primary aorto-enteric fistulae are rare, mostly described as atypical first manifestation of an abdominal aortic aneurysm. Spread of elective aortic surgery led to increased appearance of secondary aorto-enteric fistulae as a typical postoperative complication. Gastrointestinal bleeding with endoscopical unclear findings in a patient with aortic aneurysm or history of aortic repair points towards an aorto-enteric fistula. While preoperative diagnosis is not possible in most instances, the proof of an anastomotic aneurysm and/or aortic graft infection hardens the suspected diagnosis of an aorto-enteric fistula decisively. The finding of coincidental mucosal lesions at gastroscopy may not mislead to give up the exclusion of an aorto-enteric fistula, possibly by explorative laparotomy, if suspicion is well-founded. In the present article nine cases of aorto-enteric fistulae treated at the Surgical University Clinic Würzburg between 1982 and 1993 are analyzed retrospectively. Topical questions of diagnosis and therapy are discussed.
原发性主动脉肠瘘很少见，大多被描述为腹主动脉瘤的非典型首发表现。择期主动脉手术的普及导致继发性主动脉肠瘘作为典型的术后并发症出现得越来越多。主动脉瘤患者或有主动脉修复史的患者出现不明原因的胃肠道出血且内镜检查无明确发现时，应考虑主动脉肠瘘。虽然大多数情况下术前无法诊断，但吻合口动脉瘤和/或主动脉移植物感染的证据能决定性地强化主动脉肠瘘的疑似诊断。如果怀疑有充分依据，胃镜检查发现同时存在的黏膜病变时，不应因之而放弃通过剖腹探查术排除主动脉肠瘘的可能性。本文回顾性分析了1982年至1993年间在维尔茨堡大学外科诊所治疗的9例主动脉肠瘘病例。讨论了诊断和治疗的相关问题。
