Aortoenteric fistula: clinical features, diagnostic challenges, and surgical outcomes - a retrospective analysis of 10 cases.

BACKGROUND

Aortoenteric fistula (AEF) is a rare but life-threatening cause of gastrointestinal hemorrhage, often presenting diagnostic challenges and associated with high mortality. Secondary AEF (SAEF), typically related to previous aortic grafting, accounts for most cases. Optimal surgical management and perioperative strategies remain under debate. This study analyzed the clinical characteristics, diagnostic modalities, surgical techniques, and outcomes of patients with AEF to provide insights for guiding future treatment approaches.

METHODS

Retrospective analysis of 10 patients surgically treated for AEF at Guangdong Provincial People’s Hospital (2022–2024). Data included demographics, comorbidities, presentation, diagnostics, procedures, complications, and outcomes. All had preoperative imaging and surgery.

RESULTS

Ten patients, all male with a median age of 68 years (interquartile range [IQR] 59–71), comprised 8 SAEF and 2 primary AEF. Fistulas were duodenal (n = 7) and jejunal (n = 3). Presentation: GI hemorrhage (60%), abdominal pain (70%), fever (70%). CTA diagnosed AEF in all 10 patients; EGD (n = 3) was diagnostic in only one. All underwent successful open repair (aneurysm resection, vascular reconstruction, bowel repair). Intraoperative gastroscopy localized the fistula in one case. Postoperative complications occurred in five patients (50%): septic shock (30%), hemorrhage (20%), anastomotic leakage (20%). Two patients (20%) died from severe complications.

CONCLUSION

In this study, all patients underwent open surgical repair, including aneurysm resection, vascular graft replacement, and intestinal reconstruction. However, postoperative complications were common, and some patients experienced poor outcomes despite timely intervention. These findings highlight the importance of early diagnosis using CTA and prompt surgical management to improve patient prognosis.