title: Unusual presentations of aorto-enteric fistula.
abstract: BACKGROUND
  Aorto-enteric fistula is rare but can result in exsanguination without timely surgery or endovascular stent placement.
  
  
  METHODS
  Four cases of aorto-enteric fistula were reviewed in which the presentation was unusual and diagnosis difficult.
  
  
  METHODS
  The first patient had an aorto-sigmoid fistula in the setting of an aorto-bi-femoral graft. Two patients had a primary aorto-enteric fistula, one to the stomach from a suprarenal aortic aneurysm, and the other, to the duodenum in the setting of retroperitoneal spread of renal cancer. The aortoduodenal fistula recurred in the 4th patient within 3 months of surgical repair; this patient is the only one who survived long term.
  
  
  CONCLUSIONS
  When presentation is atypical, the diagnosis of aorto-enteric fistula can be extremely difficult. Because investigative studies are not consistently useful in making a definitive pre-operative diagnosis, a strong index of clinical suspicion and a willingness to consider surgical exploration are essential for timely and successful management.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: Srihari
authors.initials: S
authors.lastname: Ramanujam
authors.forename: Aaron
authors.initials: A
authors.lastname: Shiels
authors.forename: Gary
authors.initials: G
authors.lastname: Zuckerman
authors.forename: Chandra
authors.initials: C
authors.lastname: Prakash
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005747:Gastric Fistula / Q000175:diagnosis*; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012810:Sigmoid Diseases / Q000175:diagnosis*; D016157:Vascular Fistula / Q000175:diagnosis*