Aortoenteric fistula: Case series from a tertiary center in Taiwan

Aortoenteric fistula, a rare and catastrophic medical condition usually relevant to previous aortic surgery and other rare causes, is a disease that needs a multidisciplinary team including gastroenterologist, radiologist, and cardiovascular surgeon to deal with. Computed tomography with/without angiography is the choice of image study for diagnosis. Esophagogastroduodenoscopy also plays an important role in diagnosis. Exploratory laparotomy is usually mandatory because of difficulties in diagnosis and emergent condition. Aortic repair is the definite treatment and it could be done via open or endovascular surgery. From 2005 to 2017, total six patients who had the diagnosis of aortoenteric fistula (AEF) were collected from a tertiary center in Taiwan. Demographic data, diagnostic approach, treatment, and prognosis were all recorded. Among the six patients, the clinical presentations were gastrointestinal bleeding (GIB) (100%), abdominal pain (50%), and unstable hemodynamics (50%). Computed tomography angiography showed clues for AEF in four out of five patients. Four patients had definite diagnosis after open surgery. The survival time from initial presentation ranges from few hours to 29 months (median: 4.5 months). The most common manifestation of AEF is GIB. Due to its high mortality rate and difficult diagnosis, we should remind us of this rare disease for early diagnose and timely treatment.