2021 Volume 30 Issue 3 Pages 189-193
Objectives: Abdominal aorto-enteric fistula (AEF) has many problems to be resolved such as bleeding and infection, and a treatment strategy has not been established. We have experienced successful treatment of several AEF cases and we report our treatment strategy. Methods: The important points as a treatment strategy of AEF are 1) rapid control of bleeding, 2) fistula treatment, and 3) infection control. First, bleeding is controlled with an endovascular aneurysm repair (EVAR), and after confirmation of no endoleaks, intestinal tract repair and omentopexy are performed by laparotomy. The stent graft is not removed due to the priority of minimal invasion. The most suitable antibiotics are selected from the results of intraoperative culture and administered for a sufficiently long period. Results: We experienced five cases of AEF from 2016 to 2020. Three cases were primary AEF (abdominal aortic aneurysm-duodenal fistula) and two cases were secondary AEF. Of the two cases, one was after EVAR (abdominal aortic aneurysm-duodenal fistula) and one was after traditional open repair (pseudoaneurysm of proximal anastomosis-small intestinal fistula). Bleeding was controlled by immediate EVAR except for one patient with a history of EVAR. After that, intestinal repair by laparotomy was performed in all cases. Omentopexy was performed in four cases and remaining one case was used mesentery because the omentum was absent due to total gastrectomy. As for antibiotics, penicillins or cephalosporins were administered intravenously for about 4 weeks and transferred to oral administration. Although one patient died of postoperative pneumonia, four patients were discharged from the hospital. An average of 17.8 months (2.1 to 53.8 months) has passed after surgery, and there are no signs of infection due to AEF. Conclusion: A treatment strategy for AEF focusing on rapid bleeding control, fistula treatment, and infection control has good results.
