An aortoenteric fistula is a rare but life threatening complication of aortic surgery requiring immediate surgical repair. Early symptoms include abdominal pain or vomiting blood.

A fistula is an abnormal connection between two spaces in your body. An aortoenteric fistula (AEF) is a hole that connects your gastrointestinal (GI) tract with your aorta, the main artery that carries blood away from your heart.

The most common cause of an AEF is complications from aorta surgery. It can also occur as a complication of conditions that cause aortic inflammation.

Without prompt treatment to repair your aorta, an AEF causes massive GI bleeding and is almost always fatal. Emergency surgery can potentially be lifesaving.

Read on to learn about this serious condition, including its causes, symptoms, and treatment options.

An AEF is an abnormal connection between your aorta and your GI tract. Your aorta is the largest blood vessel in your body. It carries blood from your heart to the rest of your body. The duodenum, or the upper part of your small intestines, is the most commonly affected part of your GI tract.

AEFs are extremely rare, occurring in an estimated 1 in 143 million people per year.

An AEF can be primary or secondary. Primary fistulas are less common. They develop due to direct friction and inflammation of your aorta. Underlying causes can include:

Secondary AEFs develop following surgery of your aorta, typically after receiving a synthetic graft to treat an abdominal aortic aneurysm.

There’s a relatively high risk of developing a fistula after open aortic artery repair compared with endovascular repair. Open repair means that a surgeon treats an aneurysm through a large incision to access your aorta. Endovascular surgery involves using a thin tube doctors insert into your bloodstream.

AEFs are more common in males. Abdominal aortic aneurysms and aortic surgery are also more common in males.

AEFs often present with massive and hard-to-control GI bleeding that can lead to shock and death.

Other signs and symptoms include:

In a 2021 study, GI bleeding was among the initial symptoms in 60% of 57 people treated at one medical center from 1999–2019 for secondary AEFs. Abdominal pain was among the initial symptoms in 56% of people.

When to call 911

GI bleeding is a medical emergency that requires immediate medical attention. It’s critical to see a doctor if you develop symptoms such as:

Potential complications that can occur from the fistula or treatment for the fistula include:

If a doctor suspects AEF, they’ll proceed directly to surgery without further tests. About two-thirds of diagnoses are made in the operating room. Many diagnoses aren’t made until the autopsy report after death.

If you don’t have a history of aortic surgical repair or an aortic aneurysm, a doctor might need to run other tests before suspecting an AEF. Tests may include:

AEFs require immediate surgery to avoid life threatening complications. Doctors can perform surgery through a traditional open procedure or a less-invasive endovascular approach.

The goals of surgery are to:

  • stop the bleeding
  • confirm the diagnosis
  • repair the damaged part of your aorta

Open repair

During an open repair, a doctor will make a large incision in your abdomen to access your aorta. They’ll then repair the fistula. They may also remove the graft from a previous surgery as well as any dead or infected tissue.

Open surgery is associated with lower rates of sepsis or postsurgical infection for people in good enough overall health to handle the increased physical demand of the surgery.

Endovascular repair

Doctors perform endovascular surgery by accessing your aorta from within your blood vessel. Your surgeon will make an incision over one of your arteries, often in your groin, and insert a long, thin tube with special tools until it reaches your aorta. They’ll use this tube to repair your fistula.

Endovascular repair is generally the preferred technique for people with primary AEFs without signs of infection. Doctors also often use it to stabilize critically ill people with secondary AEFs or those not in good enough health to undergo open surgery.

An AEF repair is a potentially lifesaving procedure. Without surgery, the mortality rate of someone with an AEF is essentially 100%.

In a 2021 study, researchers reported the following mortality rates among 57 people who received surgery to treat secondary AEFs:

TimeframeMortality rate
30 days35%
90 days39%
180 days42%

The researchers also found that 70% of people developed complications, with GI complications being the most common.

Here are some frequently asked questions people have about AEFs.

What is the mortality rate for aortoenteric fistula?

Without treatment, people with AEFs have a mortality rate of effectively 100%. Many people die before they receive a diagnosis. In a 2021 study, the 30-day mortality rate among people who received surgical repair for secondary AEFs was 35%.

Is aortoenteric fistula painful?

Abdominal pain is one of the most common symptoms of AEF. More than half of people with AEF report it as one of the initial symptoms. Pain may come on suddenly and be intense.

How long is recovery after aortoenteric fistula repair?

It can take weeks to months to recover fully from aortic surgery. It often takes 6–12 weeks to be able to return to work following open abdominal aortic aneurysm repair.

An AEF is a medical emergency where your aorta becomes connected with your GI tract. It can cause life threatening GI bleeding that requires immediate surgical repair.

AEFs are extremely rare and usually occur as a complication of aortic surgery. It’s essential to get immediate medical attention any time you develop symptoms of GI bleeding, such as vomiting blood or finding blood in your stools.