Positive blood culture as an aid in the diagnosis of secondary aortoenteric fistula
D. Rosenthal, R. A. Deterling Jr, T. F. O'Donnell Jr and A. D. Callow
The successful management of aortoenteric fistula (AEF) requires early
diagnosis. To evaluate the accuracy of our diagnostic approach, the
hospital course of seven patients with AEF was reviewed. In six patients,
the initial bleeding episodes were of the low volume type characterized by
hematemesis and melena or by melena alone. All patients were febrile. In
six patients, blood cultures obtained preoperatively were positive for
enteric organisms identical to those found in cultures obtained
intraoperatively from the AEF site. Roentgenographic examination of the
upper gastrointestinal (GI) tract performed in three patients was
diagnostic for AEF in only one. Endoscopy in seven patients revealed a
bleeding suture line in one. Angiography was not diagnostic in the six
patients in whom it was performed. When patients are seen with the triad of
GI bleeding, a history of aortic surgery, and fever, aerobic and anaerobic
blood cultures should be obtained. If blood cultures are positive for
enteric organisms, the diagnosis of AEF should be strongly suspected, and
early surgical intervention is indicated.
