THE SURGICAL MANAGEMENT OF AORTOENTERIC FISTULAS - 11/09/11
Résumé |
An aortoenteric fistula (AEF) may be defined as a communication between the aorta and an adjacent loop of bowel. Depending on the underlying cause, a primary or secondary classification is assigned. A primary fistula arises without a previous history of aortic repair or intervention and typically results from erosion of an enlarged or infected native aorta into the anterior duodenum. A secondary fistula occurs after a vascular procedure and involves prosthetic graft material such as a suture line. Secondary fistulas occur more frequently and are recognized complications of prosthetic arterial grafts.
In more than half of primary AEF, aneurysmal dilation of the abdominal aorta with erosion or rupture into the adjacent overlying third and fourth portions of the retroperitoneal duodenum is most frequently encountered, although other sites of erosion have been found extending to adjacent loops of bowel. Fistulas resulting from primary infections of the aorta and subsequent rupture into the duodenum are the other major type of primary AEF. Tuberculosis, salmonella, syphilis, and mycotic species have all been reported to be causative organisms.38 Other sources for primary fistulas include gallstones, periaortic malignancies and metastases,1, 19 ulcers,46 diverticular and appendiceal abscesses,21 radiation therapy,17 cystic medial necrosis,41 and swallowed foreign bodies.30
Secondary AEF develops between previously placed interposition aortic graft material and the adherent anterior duodenum, usually involving the proximal anastomosis. Presentation can be seen months to years following the original operation. Failure to separate the aortic prosthesis from overlying bowel, usually by closing the aneurysm shell and retroperitoneal tissue or interposing omentum, may increase the likelihood of this occurrence.26 Inadequate retroperitonealization at the time of graft implantation, redundant graft, emergency operations for ruptured aortic aneurysms, contamination with enteric contents, and the type of suture material used all have been reported to predispose to this condition.8, 14, 16
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| Address reprint requests to Samuel E. Wilson, MD, Department of Surgery, University of California, Irvine, Medical Center, 101 The City Drive South, Orange, CA 92868 |
Vol 76 - N° 5
P. 1147-1157 - octobre 1996 Retour au numéro
Article précédent
- SURGICAL MANAGEMENT AND TREATMENT OF GASTRIC AND DUODENAL FISTULAS
- Maureen A. Chung, Harold J. Wanebo
- SURGICAL MANAGEMENT AND TREATMENT OF PANCREATIC FISTULAS
- Michael G. Ridgeway, Bruce E. Stabile
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