Aorto-enteric Fistula Following Abdominal Aorta Surgery
Forty-six aorto-enteric fistuiae following abdominal aorta surgery are here recorded. A number of these have never before been recorded in the literature. For the first time sixteen cases of these aorto-enteric fistulae that were subjected to surgical intervention have been tabulated. Twelve of these had definitive surgery either immediately or eventually. The definitive procedures are also tabulated. An attempt was made to produce a fistula in dogs. Of twelve dogs, one died six months postoperatively of massive rectal hemorrhage due to an aortoduodenal fistula that followed the implantation of a Teflon vessel graft into the abdominal aorta. The cause of this fistula was infection and a hematoma. The etiologic factors for the development of these fistulae are recorded from the literature and from personal communications. These factors are: use of homografts, use of nylon grafts, poor vessel suture technic, formation of a hematoma at the suture line, too great porosity of synthetic grafts, infection of the graft, injury of the host vessel. pulsatile thrust of the aorta, redundancy of the grafts, and direct contact of bowel with the vessel anastomosis. Successful treatment of an aorto-enteric fistula following abdominal aortic surgery requires the following: prompt recognition of the presence of the fistula, control of hemorrhage, resection of the homograft or nylon graft, replacement of the graft with a Dacron or Teflon prosthesis, interposition of living tissue between the vessel anastomosis and the bowel, and careful placement of sutures in the vessel anastomosis. If infection of the graft coexists the graft must be excised and the aorta closed by sutures.
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