When to Suspect an Aortoenteric Fistulae

  • Anita Kumar
  • Maxine Le Saux
  • Andrew C. MeltzerEmail author


Aortoenteric fistulas are rare, but it is a life-threatening condition which should be suspected early whenever a patient has a history of aortic surgery, known as aortic aneurysm, or unexplained massive gastrointestinal hemorrhage. There are two types of aortoenteric fistulas, primary and secondary. Primary fistulas are likely to present with a preceding minor gastrointestinal bleed known as a herald bleed. Secondary fistulas occur after abdominal aortic surgery.


Aortoenteric fistula Herald bleed CT angiography 


  1. 1.
    Batt M, Jean-Baptiste E, O’Connor S, et al. Early and late results of contemporary management of 37 secondary Aortoenteric fistulae. Eur J Vasc Endovasc Surg. 2011;41(6):748–57.CrossRefGoogle Scholar
  2. 2.
    Busuttil SJ, Goldstone J. Diagnosis and management of aortoenteric fistulas. Semin Vasc Surg. 2001;14(4):302–11.CrossRefGoogle Scholar
  3. 3.
    Saers SJF, Scheltinga MRM. Primary aortoenteric fistula. Br J Surg. 2005;92(2):143–52.CrossRefGoogle Scholar
  4. 4.
    Zhang X, Liu J, Li J, et al. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope. 2011;121(2):267–72.CrossRefGoogle Scholar
  5. 5.
    Deijen CL, Smulders YM, Coveliers HME, Wisselink W, Rauwerda JA, Hoksbergen AWJ. The importance of early diagnosis and treatment of patients with aortoenteric fistulas presenting with herald bleeds. Ann Vasc Surg. 2016;36:28–34.CrossRefGoogle Scholar
  6. 6.
    Simó Alari F, Molina González E, Gutierrez I, Ahamdanech-Idrissi A. Secondary aortoduodenal fistula and the unrecognised herald bleed. BMJ Case Rep. 2017;2017:bcr-2017–220186.Google Scholar
  7. 7.
    Sipe A, McWilliams SR, Saling L, Raptis C, Mellnick V, Bhalla S. The red connection: a review of aortic and arterial fistulae with an emphasis on CT findings. Emerg Radiol. 2017;24(1):73–80.CrossRefGoogle Scholar
  8. 8.
    Hughes FM, Kavanagh D, Barry M, Owens A, MacErlaine DP, Malone DE. Aortoenteric fistula: a diagnostic dilemma. Abdom Imaging. 2007;32(3):398–402.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anita Kumar
    • 1
  • Maxine Le Saux
    • 2
  • Andrew C. Meltzer
    • 2
    Email author
  1. 1.George Washington University School of Medicine & Health Sciences, Department of Medicine, Division of GastroenterologyWashington, DCUSA
  2. 2.Department of Emergency MedicineGeorge Washington University School of Medicine & Health SciencesWashington, DCUSA

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