Gastroenterological Aspects of Primary Aorto-Enteric Fistulae (PAEF)

Abstract

Background: Gastrointestinal haemorrhage associated with a primary aorto-enteric fistula (PAEF) is potentially lethal. The aims of this study were to discuss the gastrointestinal characteristics of PAEF, to identify associated laboratory findings and to discuss pitfalls in pre-operative diagnostics. Methods: Medical and surgical charts of patients with PAEF.

Results: Individuals with PAEF (n = 7, 68 ± 5 years) presented with multiple episodes of haematemesis (n = 5) and/or melaena (n = 6), all in the presence of aneurysmatic aortas (5.4 ± 1.0 cm). Laboratory testing reflected a state of acute (C-reactive protein, CRP, 94 ± 12 mg/ml ; leucocyte counts, 12.0 ± 1.0.107L) and chronic inflammation (erytrocyte sedimentation rate, ESR 52 ± 5 mm/hr). Prior to operation, a gastroduodenoscopy correctly diagnosed only one PAEF patient and CT scans identified 3. Two patients exsanguinated in a two-week waiting period prior to corrective surgery. Conclusions: Recurrent gastrointestinal blood loss in the presence of an aneurysm requires urgent gastroduodenoscopic evaluation. Computer tomography is sensitive in providing direct or circumstantial evidence of a fistula. A combined acute and chronic inflammatory state associated with PAEF is reflected by elevations of CRP and ESR. A PAEF is a unique form of ruptured aneurysm, and this entity mandates imminent radiological and surgical consultation aimed at instituting aggressive treatment within hours.

Key word:

• Aorto-enteric fistula.

Additional information

Notes on contributors

S.J.F. Saers

Dr. M. R. M. Scheltinga Department of Surgery Máxima Medical Centre Veldhoven De Run 4600 5500 MB Veldhoven, The Netherlands Tel.: [phone] Fax: [phone] E-mail: [email protected]

M.R.M. Scheltinga

Dr. M. R. M. Scheltinga Department of Surgery Máxima Medical Centre Veldhoven De Run 4600 5500 MB Veldhoven, The Netherlands Tel.: [phone] Fax: [phone] E-mail: [email protected]

J.M.J.I. Salemans

Dr. M. R. M. Scheltinga Department of Surgery Máxima Medical Centre Veldhoven De Run 4600 5500 MB Veldhoven, The Netherlands Tel.: [phone] Fax: [phone] E-mail: [email protected]

P.J. Kitslaar

Dr. M. R. M. Scheltinga Department of Surgery Máxima Medical Centre Veldhoven De Run 4600 5500 MB Veldhoven, The Netherlands Tel.: [phone] Fax: [phone] E-mail: [email protected]