Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting w...Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.展开更多
Aorto-enteric fistula(AEF)is a rare entity that accounts for high mortality. Early diagnosis is paramount to improving the survivals of patients with AEF but the diagnosis tends to be delayed in practice due to extrem...Aorto-enteric fistula(AEF)is a rare entity that accounts for high mortality. Early diagnosis is paramount to improving the survivals of patients with AEF but the diagnosis tends to be delayed in practice due to extremely variable clinical presentations. Contrasted computer tomography(CT),oesophagastroduodenoscopy(OGDS)or angiography should be prompted in a timely manner based on a high index of clinical suspicion. In this article,a case of primary AEF(PAEF)with herald gastroenteric tract haemorrhage is presented. In addition to the pathophysiology and managements,the pitfalls of the diagnostic studies are discussed,pinpointing the importance of high index of clinical suspicion.展开更多
文摘Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.
文摘Aorto-enteric fistula(AEF)is a rare entity that accounts for high mortality. Early diagnosis is paramount to improving the survivals of patients with AEF but the diagnosis tends to be delayed in practice due to extremely variable clinical presentations. Contrasted computer tomography(CT),oesophagastroduodenoscopy(OGDS)or angiography should be prompted in a timely manner based on a high index of clinical suspicion. In this article,a case of primary AEF(PAEF)with herald gastroenteric tract haemorrhage is presented. In addition to the pathophysiology and managements,the pitfalls of the diagnostic studies are discussed,pinpointing the importance of high index of clinical suspicion.
