[The aorto-enteric fistula--a rare, but important cause of upper gastrointestinal hemorrhage].

During the last two years two patients with upper gastrointestinal bleeding caused by an aortoenteric fistula were admitted to the hospital. The first patient had a primary fistula between an arteriosclerotic aneurysm of the abdominal aorta and the duodenum. The second patient had an infected aortobifemoral graft which had penetrated into the upper jejunum. The aortoenteric fistula is one of the very rare causes of upper gastrointestinal bleeding. Referring to previous surgery at the aorta a primary and secondary type of fistula are differentiated. The primary fistula often induces a small initial bleeding followed by a severe hemorrhage with hematemesis and melaena. The secondary form is mostly caused by bacterial infection of the graft. Recurrent fever attacks are a common clinical symptom without any evidence of the origin of the bacteriemia. Principally the combination of upper gastrointestinal bleeding and aortic graft is always suspicious of an aortoenteric fistula. The most important preoperative examinations are endoscopy, computed tomography scan, and arteriography. The treatment must be surgical. Either a synthetic graft surrounded by omentum is implanted or an axillobifemoral or aortobifemoral bypass is constructed. Even if the diagnosis is made early mortality of the disease is about 20-30%.