Aortoenteric fisulta

(Redirected from Aortoenteric fistula)


  • Fistula formed between aorta and intestines
    • Can be primary or secondary (often due to AAA repair)
    • Can form fistula anytime within life of AAA graft repair
      • Higher risk with recent graft placement
  • Involves the duodenum (ADF) in most cases[1]
  • Incidence of primary aortoenteric fistulas is estimated to be about 0.007 per million while secondary aortoenteric fistulas is about 0.6-2%
  • Mortality of 100% if left untreated

Clinical Features

Differential Diagnosis

Upper gastrointestinal bleeding

Mimics of GI Bleeding

Undifferentiated lower gastrointestinal bleeding


Aortoenteric fistula and aortic dissection of the thoracic aorta. Arrow shows the flap in the aorta. Heterogeneity is blood in the stomach.
Aortoenteric fistula on CT showing extensive atherosclerosis of abdominal aorta and an infrarenal thrombosed aneurysm. In the extension of the thrombosed aneurysm, a soft tissue density is extending anteriorly (arrow), adherent to the duodenum and slightly compressing it.

If suspicion high, involve vascular surgery early

  • CBC
  • Chem 10
  • Type and Cross
  • Blood culture if fever - high risk for infections with secondary fistulas (ie grafts)
  • Aortic ultrasound and FAST exam to assess for AAA and Free Fluid
  • CXR for pre-op, if patient stable
  • ECG for pre-op
  • CTA of abdomen/pelvis, highly sensitive, if patient stable
  • Patient may need gastroduodenal endoscopy



  • Admission

External Links


  1. Rodrigues dos Santos et al. Enteric repair in aortoduodenal fistulas: a forgotten but often lethal player. Ann Vasc Surg. 2014 Apr;28(3):756-62. doi: 10.1016/j.avsg.2013.09.004. Epub 2013 Oct 1.