Case Report

Primary Aortoenteric Fistulae: What Every Surgeon Should Know About Its Diagnosis and Treatment


Aortoenteric fistula is a rare finding that is potentially fatal and is usually seen as a fistula between the aorta or an aortic graft and the third part of the duodenum. The type without the presence of an artificial graft is considered as primary and the other type as secondary. The patients usually present with the heralding symptom of minor hematemesis, which later leads to massive and mortal GI bleeding. The most important factor in the diagnosis of an aortoenteric fistula is to have a high clinical suspicion after taking an appropriate and accurate history. In hemodynamically stable patients with clinical suspicion, performing an intravenous-contrast-CT scan of the abdomen and pelvis is of assistance in diagnosis. In general, stable hemodynamics greatly reduces the suspicion for diagnosis. Treatment is often surgical, and in regard to the severity of abdominal contamination or the level of visible infection, the extra anatomical or insitu graft repair is considered as the method of choice. This article tries to transfer our experiences in two patients, each of whom presented with hematemesis and melena without a history of underlying aortic aneurysm.

1. Genovés-Gascó B, Torres-Blanco Á, Plaza-Martínez Á, Olmos-Sánchez D, Gómez-Palonés F, Ortiz-Monzón E. Primary aortoduodenal fistula in a patient with pararenal abdominal aortic aneurysm. Ann Vasc Surg 2012;26:730.e1-5
2. Beuran M, Negoi I, Negoi RI, Hostiuc S, Paun S. Primary Aortoduodenal Fistula: First you Should Suspect it. Braz J Cardiovasc Surg 2016;31:261-3.
3. Antoniou GA, Koutsias S, Antoniou SA, Georgiakakis A, Lazarides MK, Giannoukas AD. Outcome after endovascular stent graft repair of aortoenteric fistula: a systematic review. J Vasc Surg 2009;49:782-9.
4. Korkut AK, Arpinar E, Yasar T, Guney D. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm. J Cardiovasc Surg 2000;41:113-5.
5. Lemos DW, Raffetto JD, Moore TC, Menzoian JO. Primary aortoduodenal fistula: A case report and review of the literature. J Vasc Surg 2003;37:686-9.
6. Gad A. Aortoduodenal fistula revisited. Scand J Gastroenterol Suppl 1989;24:97-100.
7. Reynolds JY, Galloway JMD. Primary aortoduodenal fistula: a case report and review of the literature. Ir J Med Sci 1991;160:381-4.
8. Farber A, Grigoryants V, Palac DM, Chapman T, Cronenwett JL, Powell RJ. Primary aortoduodenal fistula in a patient with a history of intravesical therapy for bladder cancer with bacillus Calmette-Guerin: review of primary aortoduodenal fistula without abdominal aortic aneurysm. J Vasc Surg 2001;33:868-73.
9. Busuttil RW, Rees W, Baker JD, Wilson SE. Pathogenesis of aortoduodenal fistula: experimental and clinical correlates. Surgery 1979;85:1-13.
10. Ikolnomopoulos DC, Spanos PK, Lazarides DP. Pathogenesis of aortoenteric fistula: an experimental study. Int Angiol 1986;5:33-7.
11. Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: manifestations, diagnosis and treatment. Surgery 1984;96:492-7.
12. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg 2005;92:143-52
13. Champion MC, Sullivan SN, Watson WC. Aortoduodenal fistula endoscopic diagnosis. Dig Dis Sci 1980;25:811-2.
14. Yamashita A, Noma T, Nakazawa A, Saito S, Fujioka K, Zempo N, et al. Enhanced expression of matrix metaloproteinase-9 in abdominal aortic aneurysms. World J Surg 2001;25:259-65.
15. Pagni S, Denatale RW, Sweeney T, McLaughlin C, Ferneini AM. Primary aorto-duodenal fistula secondary to infected abdominal aortic aneurysms: the role of local debridement and extra-anatomic bypass. J Cardiovasc Surg 1999;40:31-5
16. Steffes BC, O’Leary JP. Primary aortoduodenal fistula: acase report and review of literature. Am Surg 1980;46:121-9.
17. Daugherty M, Shearer GR, Ernst CB. Primary aortoduodenal fistula: extra-anatomic vascular reconstruction not required for successful management. Surgery 1979;86:399-401.
IssueVol 59, No 1 (2021) QRcode
SectionCase Report(s)
Primary aortoenteric fistulae Secondary aortoenteric fistulae Mortal gastrointestinal (GI) bleeding

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Hassani M, Bakhshaei Shahrbabaki P, Zarrintan S, Moradmand M. Primary Aortoenteric Fistulae: What Every Surgeon Should Know About Its Diagnosis and Treatment. Acta Med Iran. 2021;59(1):60-63.