Aortoenteric fistula is a rare cause of massive upper gastrointestinal bleeding with a high degree of mortality. Fistulization can occur either primarily or secondarily, with secondary causes being more common. Primary causes arise via the native aorta, while secondary causes result from previous surgical interventions on the aorta when, most commonly, a synthetic graft material erodes into the adjacent enteric system. Presentation is variable but most commonly includes an upper GI bleed coupled with the knowledge of a prior aortic operation or the presence of an aortic aneurysm.
Patients can decompensate quickly, and treatment is anchored in rapid diagnosis and early repair, either open or endovascular. The endovascular repair offers a less physiologically demanding repair that may serve as a bridging therapy to definitive surgical management. Complications following a repair are common, and mortality remains high for patients who develop aortoenteric fistulas.
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