[Aorto-intestinal and paraprosthetic fistulas. A rare differential diagnosis of gastrointestinal hemorrhage].

Secondary aorto-intestinal or paraprosthetic fistulas had developed in seven patients after implantation of an angioprosthesis. In six cases, the fistula was located in the duodenum, in each case after a bifurcation bypass had been established, whereas in one case the fistula occurred in the area of the caecum (unilateral aortofemoral bypass as preliminary operation). Gastrointestinal bleeding was the initial sign in five patients, preceding in each case the final massive haemorrhage as a typical premonitory haemorrhage by several days. A secondary aorto-intestinal fistula must be assumed if there is a constellation of acute gastrointestinal bleeding, sepsis or fever and previous aorto-iliacal bypass operation, unless it is possible to confirm some other source of haemorrhage by endoscopy. The present-day standard therapy consists in occluding the intestinal fistula opening, removal of the entire prosthetic material and, if necessary, establishment of an extra-anatomic axillofemoral bypass.