title: Primary aorto-enteric fistula in a 52-year-old man.
abstract: BACKGROUND
  Aorto/ilio enteric Fistula (AEF) is defined as a communication between the aorta or iliac artery and any adjacent segment of the bowel. It may be primary or secondary. The former occurs in patients with intestinal or vascular disease and mostly complicates abdominal aortic aneurysm (AAA), whereas secondary aorto-enteric fistula is a dreadful complication of aortic reconstruction with vascular prosthesis. THE AIM of this study is to report this case of unusual presentation of PAEF as a rare cause of low enteric bleeding and discuss the path physiology, etiology, diagnosis and management of this entity.
  
  
  METHODS
  The authors report a case of 52-year-old man who presented with acute rectal bleeding. Esophago-gastro-duodenoscopy and colonoscopy were non diagnostic. Because of persistence of bleeding and hemodynamic instability, patient underwent urgent laparotomy. At surgery, diagnosis of primary aorto enteric fistula (PAEF) was made between the right iliac artery and the sigmoid complicating an iliac pseudo aneurysm. Direct repair of the vascular and digestive defects and sigmoidostomy were performed. The patient died two hours after surgery of cardiac arrest.
  
  
  CONCLUSIONS
  AEF is a rare but a life threatening cause of GI bleeding. A delay in identification, as in our observation, may partly explain the high morality and morbidity.
authors.affiliation: Department A of General Surgery of Charles Nicole Hospital, Tunis, Tunisia.
authors.forename: Slim
authors.initials: S
authors.lastname: Jarboui
authors.forename: Hichem
authors.initials: H
authors.lastname: Jarraya
authors.forename: Wassim
authors.initials: W
authors.lastname: Mahjoub
authors.forename: Mondher
authors.initials: M
authors.lastname: Baccar
authors.forename: Chakib
authors.initials: C
authors.lastname: Kacem
authors.forename: Morched M
authors.initials: MM
authors.lastname: Abdesselem
authors.forename: Abdeljelil
authors.initials: A
authors.lastname: Zaouche
mesh_terms: D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000175:diagnosis; D001159:Arterio-Arterial Fistula / Q000175:diagnosis; D017809:Fatal Outcome; D006801:Humans; D007083:Iliac Artery; D007412:Intestinal Fistula / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012810:Sigmoid Diseases / Q000175:diagnosis