Aortoenteric fistula: case review and a new surgical technique.

The authors describe a new surgical technique for the management of aortoenteric fistula and report on the diagnosis and management of five such cases. The new technique consists of stapling the afferent and efferent loops of bowel as close to the fistula as possible. In a bleeding patient this effectively stops the blood loss into the bowel; when a patient is not actively bleeding, it helps in the retraction of the bowel away from the operative site. The authors propose that this technique be used by a surgeon with limited vascular experience to temporize the blood loss and transport the patient to a vascular unit. The recommended procedure is total excision of the graft with an axillobifemoral bypass. Acute awareness of the condition and prompt early operation in a patient who has undergone aortic surgery will result in lower death rates.