Huang W S, Chiu K W, Changchien C S
Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Chang Gung Med J. 2000 Jan;23(1):48-51.
Aortoenteric fistula is a rare condition that may cause death in patients due to gastrointestinal bleeding. The duodenum is the most frequently involved site, at 78.5% of 191 cases by Nagy and Marshall's meta-analysis. It is characterized by the clinical triad of abdominal pain, gastrointestinal bleeding, and an abdominal mass. Abdominal computed tomography is the most useful tool in detecting an aortoenteric fistula. To prevent a high mortality rate, early diagnosis is necessary. Exploratory laparotomy is required for patients who are highly suspected of having an aortoduodenal fistula. Herein, we report a 60-year-old man who suffered from acute gastrointestinal bleeding, recurrent syncope, and impending shock. Abdominal computed tomography revealed a 6 cm longitudinal aneurysm in the infrarenal aorta. Emergency laparotomy was performed and revealed an aortoduodenal fistula in the fourth portion of the duodenum causing acute duodenal bleeding. The patient survived and has undergone 2 years worth of regular follow-up in our outpatient department.
主动脉肠瘘是一种罕见的疾病，可能因胃肠道出血导致患者死亡。十二指肠是最常受累的部位，根据纳吉和马歇尔的荟萃分析，在191例病例中占78.5%。其特征为腹痛、胃肠道出血和腹部肿块的临床三联征。腹部计算机断层扫描是检测主动脉肠瘘最有用的工具。为防止高死亡率，早期诊断是必要的。对于高度怀疑患有主动脉十二指肠瘘的患者，需要进行剖腹探查术。在此，我们报告一名60岁男性，他患有急性胃肠道出血、反复晕厥和即将发生的休克。腹部计算机断层扫描显示肾下腹主动脉有一个6厘米长的动脉瘤。进行了急诊剖腹手术，发现十二指肠第四部分存在主动脉十二指肠瘘，导致急性十二指肠出血。患者存活下来，并在我们的门诊部接受了为期2年的定期随访。
