title: Aorto-enteric fistulas: a physiopathological approach and computed tomography diagnosis.
abstract: Infection of an abdominal aortic prosthesis with an enteroprosthetic fistula is a very serious, life-threatening complication, leading sometimes to severe functional consequences, the most serious being amputation. Since the symptoms, if there are any, are often rather non-specific, diagnosis is frequently difficult and has always to be based on a whole series of justifications. Early diagnosis is essential and this fistula should be the first possibility considered in a patient with an abdominal aortic prosthesis who is presenting rectorrhagia or melaena (even if only to a slight degree), sepsis and/or abdominal pain. Although rare, the clinical existence of hypertrophic osteoarthropathy may assist diagnosis. A CT scan is the examination of choice, the criteria providing evidence of a fistula being the presence of gaseous images in a periprosthetic fluid collection, thickening and/or retraction of the intestinal walls in contact, the existence of a false aneurysm, and finally, very rarely, extravasation of contrast agent into the intestinal lumen. The differential diagnoses that may mimic a fistula need to be well known, and can include retroperitoneal fibrosis, an infectious aneurysm, inflammatory or infectious aortitis, and above all, a 'simple' prosthesis infection without fistulisation.
authors.affiliation: Department of Adult Radiology, Hôpitaux de Brabois, CHU de Nancy, rue du Morvan, Vandœuvre-lès-Nancy cedex, France. j.mathias@chu-nancy.fr
authors.forename: J
authors.initials: J
authors.lastname: Mathias
authors.forename: E
authors.initials: E
authors.lastname: Mathias
authors.forename: F
authors.initials: F
authors.lastname: Jausset
authors.forename: A
authors.initials: A
authors.lastname: Oliver
authors.forename: C
authors.initials: C
authors.lastname: Sellal
authors.forename: V
authors.initials: V
authors.lastname: Laurent
authors.forename: D
authors.initials: D
authors.lastname: Regent
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000503:physiopathology; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001025:Aortitis / Q000000981:diagnostic imaging / Q000503:physiopathology; D001027:Aortography / Q000379:methods*; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000503:physiopathology; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D007089:Image Enhancement; D007412:Intestinal Fistula / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008551:Melena / Q000000981:diagnostic imaging / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016157:Vascular Fistula / Q000000981:diagnostic imaging* / Q000503:physiopathology*