Abdominal Imaging

, Volume 32, Issue 3, pp 398–402 | Cite as

Aortoenteric fistula: a diagnostic dilemma

  • Fiona M. Hughes
  • Dara Kavanagh
  • Mary Barry
  • Anthony Owens
  • Donal P. MacErlaine
  • Dermot E. Malone



To assess the sensitivity and specificity of computed tomography (CT) in the diagnosis of aortoenteric fistula (AEF) and to determine the most accurate CT signs of the disease.


Hospital records were reviewed over a 20-year period. Twenty-three patients in whom a final diagnosis of AEF was made at laparotomy or autopsy were identified. Ten of these had CT performed. Twelve control cases were also collected. The 22 cases, (10 cases of AEF and 12 controls), were reviewed retrospectively by two independent readers, who were blinded to the clinical features and outcome. Each case was examined for six specific radiological findings. The outcome of other adopted investigative modalities was also examined.


The presence of peri-aortic ectopic gas (>2 weeks following surgery) in the context of gastrointestinal (GI) blood loss was 100% specific for AEF. If AEF was considered to be present where signs of peri-aortic infection were present in a patient with GI bleeding, CT had an overall specificity of 100% (95% confidence interval = 1.0–1.0) and sensitivity of 50%.


CT can rule in the diagnosis of AEF but cannot rule it out. CT is recommended as the first-line investigation in a stable patient with suspected AEF.


Aorta/surgery Aortic diseases/radiography Duodenal diseases/radiography Intestinal fistula/radiography Infection/radiography Tomography, spiral computed 


  1. 1.
    Voorhoeve R, Moll FL, de Letter JA, et al. (1996) Primary aortoenteric fistula: report of eight new cases and review of the literature. Ann Vasc Surg 10:40–48PubMedCrossRefGoogle Scholar
  2. 2.
    Reilly LM, Altman H, Lusby RJ, et al. (1984) Late results following surgical management of vascular graft infection. J Vasc Surg 1(1):36–44PubMedCrossRefGoogle Scholar
  3. 3.
    O’Hara PJ, Hertzer NR, Beven EG, et al. (1986) Surgical management of infected abdominal aortic grafts: review of a 25-year experience. J Vasc Surg 3(5):725–731PubMedCrossRefGoogle Scholar
  4. 4.
    Mark AS, Moss AA, McCarthy S, et al. (1985) CT of aortoenteric fistulas. Invest Radiol 20(3):272–275PubMedCrossRefGoogle Scholar
  5. 5.
    Low RN, Wall SD, Jeffrey RB Jr, et al. (1990) Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology 175(1):157–162PubMedGoogle Scholar
  6. 6.
    Orton DF, LeVeen RF, Saigh JA, et al. (2000) Aortic prosthetic graft infections: radiologic manifestations and implications for management. Radiographics 20(4):977–993PubMedGoogle Scholar
  7. 7.
    Higgins RS, Steed DL, Zajko AB, et al. (1991) Computed tomographic scan confirmation of paraprosthetic enteric fistula. Am J Surg 162(1):36–38PubMedCrossRefGoogle Scholar
  8. 8.
    Raptopoulos V, Cummings T, Smith E (1987) Computed tomography of life-threatening complications of abdominal aortic aneurysm. The disrupted aortic wall. Invest Radiol 22(5):372–376PubMedCrossRefGoogle Scholar
  9. 9.
    Maceneaney PM, Malone DE (2000) The meaning of diagnostic test results: a spreadsheet for swift data analysis. Clin Radiol 55(3):227–235PubMedCrossRefGoogle Scholar
  10. 10.
    Flye MW, Thompson WM (1983) Aortic graft-enteric and para prosthetic-enteric fistulas. Am J Surg 146:183–187PubMedCrossRefGoogle Scholar
  11. 11.
    Bunt TJ (1983) Synthetic vascular graft infection II. Graft enteric erosions and graft enteric fistulas. Surgery 94(suppl I):1–9PubMedGoogle Scholar
  12. 12.
    Kleinman LH, Towne JB, Bernard VM (1979) A diagnostic and therapeutic approach to aortoenteric fistulas: clinical experience with twenty patients. Surgery 86(6):868–880PubMedGoogle Scholar
  13. 13.
    Auffermann W, Olofsson P, Stoney R, et al. (1987) MR imaging of complications of aortic surgery. J Comput Assist Tomogr 11(6):982–989PubMedCrossRefGoogle Scholar
  14. 14.
    Reilly DT, Grigg MJ, Cunningham DA, et al. (1989) Vascular graft infection: the role of indium scanning. J Vasc Surg 3(5):393–397CrossRefGoogle Scholar
  15. 15.
    Krupnick AS, Lombardi JV, Engels FH, et al. (2003) 18-fluorodeoxyglucose positron emission tomography as a novel imaging tool for the diagnosis of aortoenteric fistula and aortic graft infection—a case report. J Vasc Endovasc Surg 37(5):363–366CrossRefGoogle Scholar
  16. 16.
    Perks FJ, Gillespie I, Patel D (2004) Multidetector computed tomography imaging of aortoenteric fistula. J Comput Assist Tomogr 28(3):343–347PubMedCrossRefGoogle Scholar
  17. 17.
    Kayani I, Groves AM, Syed R (2005) Aortoenteric fistula as shown by multidetector computed tomography. Heart 91(3):304PubMedCrossRefGoogle Scholar
  18. 18.
    Pierce RM, Jenkins RH, Maceneaney P (2005) Para prosthetic extravasations of enteric contrast: a rare and direct sign of secondary aortoenteric fistula. Am J Roentgenol 184(3 suppl):S73–S74Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Fiona M. Hughes
    • 1
    • 4
  • Dara Kavanagh
    • 2
  • Mary Barry
    • 3
  • Anthony Owens
    • 1
  • Donal P. MacErlaine
    • 1
  • Dermot E. Malone
    • 1
  1. 1.Department of RadiologySt Vincent’s University HospitalDublin 4Ireland
  2. 2.Department of General SurgerySt Columcille’s HospitalCo. DublinIreland
  3. 3.Department of Vascular SurgerySt Vincent’s University HospitalDublin 4Ireland
  4. 4.UCSD Medical CenterSan DiegoUSA

Personalised recommendations