Primary Aortoenteric Fistula Secondary to Ulcerative Atherosclerosis

Aortoenteric fistulae after replacement surgery of the aorta is a well-described phenom enon. Fewer than 200 cases of primary aortoenteric fistulae have, however, been reported. The vast majority of these reveal aortic or gastrointestinal pathology as etiolo gies. The authors report on the very rare occurrence of primary aortoenteric fistula caused by ulcerative atherosclerosis in the absence of aortic aneurysm. The index of suspicion in patients with gastrointestinal bleeding of unknown etiology must be high to accurately diagnose an aortoenteric fistula. With aggressive testing and early laparotomy if indicated, the diagnosis of aortoenteric fistula can be ascertained and surgical correction can be accomplished.