[Primary aorto-digestive fistulas. Four cases and review of the literature].

Four cases, three fatal and one with long term recovery, of patients treated surgically for primary aorto duodenal fistulas are reported. The involved lesion was an infrarenal aortic aneurysm. Two patients had an extra-anatomic vascular procedure and two patients an in situ repair. In connection with these cases, two hundred and fifty three primary aorto enteric fistulas were reviewed in the world's literature. The difficulties in the diagnosis and treatment are pointed out. Emergency operation should be performed in all cases of gastrointestinal bleeding associated with an abdominal aneurysm. The best diagnostic approach is CT scan combined to gastro-duodenoscopy. Overall mortality in our review of the literature was seventy one per cent. Closure of the enteric component should be performed with lateral repair. Management of the aortic component remains controversial: closure of the aorta and axillo-bi femoral by pass or in situ repair. The operative mortality in our review of the literature was thirty seven per cent. Interposition of viable tissue is necessary according to the risk of recurrent infection and bleeding with consequent death (twelve per cent). So, long term control is of paramount importance.