An Anatomical Approach to the Problem of Massive Gastrointestinal Hemorrhage

Kane, James M.; Meyer, Karl; Kozoll, Donald D.

doi:10.1001/archsurg.1955.01270100096017

Cited by 49 publications

(15 citation statements)

References 38 publications

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“…2 The most common site of this fistula is the third part of the duodenum, probably because of its relative fixity compared with the rest of the bowel, and its close relationship with the aorta. The most frequent cause of aortoenteric fistula is arteriosclerosis, with other less common causes being syphilis, tuberculosis, and mycotic aneurysm, 11 as well as gallstones, 12 carcinomas, 13 abscesses, 14 ulcers, 15 and foreign bodies. 16 To our knowledge, no other case of a primary aortoenteric fistula being caused by chronic aortic dissections, as in our patient, has ever been reported.…”

Section: Discussionmentioning

confidence: 99%

Primary aortoenteric fistula with a chronic isolated abdominal aortic dissection: Report of a case

et al. 1998

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A 47-year-old woman on long-term hemodialysis due to a chronic isolated abdominal aortic dissection was admitted to our department with severe abdominal pain. She had not suffered any hematemesis or melena. An emergency laparotomy revealed an abdominal aortic aneurysm with a diameter of 60mm, densely adhered to the ileum. An aortoenteric fistula manifesting as intramural rupture into the ileum was found after infrarenal abdominal aortic and bilateral common iliac cross-clamping. The fistula on the ileac side was nontransmural, but that on the aortic side communicated with the pseudolumen of the abdominal aorta, and contained mural thrombus. The infrarenal abdominal aorta and bilateral common iliac arteries were replaced with a collagen-sealed woven Dacron bifurcated graft. Histological examination of the ileum in this portion showed intramural bleeding and xanthomatous granulation with foam cell infiltration in the thickened subserosa. While it is difficult to diagnose nonpenetrating aortoenteric fistula preoperatively, such a fistula must be considered in a patient with severe abdominal pain, for whom previous abdominal aortic surgery has been performed or when an abdominal aneurysm is observed. To our knowledge, no other case of an aortoenteric fistula presenting as an intramural rupture into the ileum in an isolated abdominal aortic dissection has ever been reported.

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Section: Discussionmentioning

confidence: 99%

Primary aortoenteric fistula with a chronic isolated abdominal aortic dissection: Report of a case

et al. 1998

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“…In großen Autopsiestudien wird eine Inzidenz zwischen 0,04-0,07% aller Gastrointestinalblutungen angegeben [15,18] [1,20]. Die Bedeutung einer subklinischen lokalen Infektion in der Genese primä-rer aortoenteraler Fisteln ist dabei noch nicht vollständig geklärt [36]; ein Zusammenhang wird jedoch in der Mehrzahl der veröffentlichten Fallberichte primärer Fisteln nach Radiatio angenommen [8,21,37,38] tere wichtige pathogenetische Faktoren [8,35,36].…”

Section: Inzidenz Lokalisationunclassified

Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Drognitz

Pfeiffenberger

Schareck

et al. 2002

Chirurg

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Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

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“…They can be classified into primary aortoenteric fistula (PAEF) and secondary aortoenteric fistula (SAEF). SAEF is the more common entity (PAEF represents only ~0.4%–1.6% of all types of AEF),1 and it typically occurs as a complication from aortic reconstructive surgery where a fistulous tract is formed between the aorta and an adjacent portion of the bowel due to chronic, low-grade perigraft infection and the repetitive pressure on the intestine from aortic pulsations 2. In contrast, PAEF is rare, and has an incidence of 0.04%–0.07% in the general population and 0.69%–2.36% of patients with an abdominal aortic aneurysm (AAA), as reported in a large autopsy study 3.…”

Section: Introductionmentioning

confidence: 99%

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

et al. 2017

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A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.

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An Anatomical Approach to the Problem of Massive Gastrointestinal Hemorrhage

Cited by 49 publications

References 38 publications

Primary aortoenteric fistula with a chronic isolated abdominal aortic dissection: Report of a case

Primary aortoenteric fistula with a chronic isolated abdominal aortic dissection: Report of a case

Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding

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