Diagnosis and management of primary aortoenteric fistulas-experience learned from eighteen patients

摘要: Objective Misdiagnosis of primary aortoenteric fistula (PAEF) frequently occurs in clinical practice owing to the rarity this condition. Herein we present experience diagnosis and management for PAEF. Methods Eighteen patients with PAEF at 2 medical centers China were reviewed. The data, diagnostic procedures, treatment options, patient outcomes evaluated. Results fistulas located esophagus (5), duodenum (8), jejunum (3), ileum (1), transverse colon (1). etiologies include atherosclerotic aneurysms foreign body. Typical abdominal triad (pain, upper GI bleeding, pulsating mass) was found 27.8% patients, Chiari's (mid-thoracic pain, sentinel hemorrhage, massive bleeding after a symptom-free interval) 3 5 cases thoracic aortoesophageal fistulas. All had an average 3.6 (1-9) episodes gastrointestinal bleeding. interval between first hemorrhage ultimate exsanguination ranged from hours months (median, 4 days). Six (33.3%) diagnosed or suggested by tools including endoscopy, computerized tomography, arteriography. Others surgical exploration (7) autopsy (5). One rounds (mean 1.8) misdiagnosis occurred 15 patients. recovered surgery remained well during 36-month follow-up. options used included situ replacement vascular graft aneurysmorraphy closure endovascular stenting (2). Conclusions A high index suspicion is necessary correct prompt PAEF, especially aortoiliac presenting In stent-graft may be preferred therapeutic options.