Bleeding from aortointestinal fistula

INTRODUCTION: Aortointestinal fistula is a patological communication between the aorta and the gut. Two groups of these fistulas are described. The primary fistulas originated as complications of aneurysma of the abdominal aorta and the secondary fistulas as a consequence of reconstruction of the abdominal aorta or the iliac arteries. CASE REPORT: A case report of 69-year-old man operated for aneurysma of abdominal aorta with implanted aortal prosthesis is described. Four years after the surgery he complained for bleeding into the digestive tract. The only the small lesions of the stomach were found during endoscopy. A strong attack of bleeding which followed later recquired a laparotomy where aortoileal fistula located in distal anastomosis between the aorta and the prosthesis was found. Despite of the intensive care patient died because of haemorhagic shock. DISCUSSION AND CONCLUSION: Based on literature review and also based on the own experience author concludes that every patient with intraabodominal pulsating resistance, or with known diagnosis of the abdominal aorta aneurysma, or with aortal prosthesis who presents with features of the sepsis or bleeding into the digestive tract is suspicious from presence of aortointestinal fistula. The patient should be immediately examined by spiral CT with contrast and operated.