Internal Medicine

Aortoenteric fistula (AEF)

Connections between the aorta and gastrointestinal (GI) tract.


Primary aortoenteric fistula (PAEF) (<1% cases)

  • Abdominal aortic aneurysms (AAAs)
  • Rare causes:
    • Syphilis, tuberculosis, peptic ulcer disease, and malignancy

Secondary aortoenteric fistulas (SAEF) (M/C)

  • Aortic reconstruction 

Clinical features

Classic triad (11% cases):

  • Palpable abdominal mass
  • Abdominal pain
  • GI bleed: Hematemesis/melena (M/C symptom, 32-78% cases)

Primary aortoenteric fistulas (PAEFs):

  • Self-limited GI bleeds called “herald bleeds,”
  • Fistula often goes undiagnosed until patients undergo laparotomy for a massive GI bleed


  • Esophagogastroduodenoscopy (EGD) (first-line investigation)


CECT (imaging of choice):

  • Air within the aortic wall
  • Focal bowel wall thickening
  • Disruption of pre-aortic fat
  • Contrast in proximity or in the bowel



Endovascular treatments:

  • Retrograde balloon occlusion of the aorta
  • Stent-graft deployment
  • Coil, fibrin, and glue embolization of the fistulous tract

Surgical management:

En-bloc resection of the aortic segment and small bowel. | Rhéaume, P., Labbé, R., Thibault, E., & Gagné, J.-P. (2008). A rational, structured approach to primary aortoenteric fistula. Canadian Journal of Surgery. Journal Canadien de Chirurgie, 51(6), E125–E126. Retrieved from

Patients likely require lifelong antibiotics and remain at risk for secondary infection and refistulation.

Leave a Reply