Galloro G, De Palma G D, Siciliano S, Amato B, Catanzano C
Service of Surgical Digestive Endoscopy, School of Medicine, University of Naples Federico II, Italy.
Hepatogastroenterology. 2000 Nov-Dec;47(36):1585-7.
Secondary aortoduodenal fistula is a rare and life-threatening long-term complication of abdominal aortic surgery. Pathogenesis is often not clear; both mechanical trauma and septic procedures are involved as principal factors. The interval between first intervention and development of the fistula can vary from months to years. The presentation is often subtle with a herald bleeding followed by a period of grace, followed or not by an exsanguinating hemorrhage. The right diagnosis of aortoduodenal fistula hemorrhage can be difficult. We emphasize the need to have an early and correct diagnosis in one with differential diagnosis of patients with gastrointestinal bleeding after previous abdominal aortic replacement surgery. The esophagogastroduodenoscopy (until the Treitz) is the main diagnostic procedure, able to demonstrate the fistula and rule out other possible causes of bleeding.
继发性主动脉十二指肠瘘是腹主动脉手术罕见且危及生命的远期并发症。其发病机制往往不明；机械性创伤和感染性过程均为主要相关因素。首次干预与瘘形成之间的间隔时间可从数月至数年不等。临床表现通常较为隐匿，先有先兆性出血，随后有一段缓解期，之后可能发生或不发生致命性出血。正确诊断主动脉十二指肠瘘出血可能困难。我们强调，对于曾接受腹主动脉置换手术且出现胃肠道出血的患者，必须尽早进行正确诊断并进行鉴别诊断。食管胃十二指肠镜检查（直至屈氏韧带）是主要的诊断方法，能够显示瘘并排除其他可能的出血原因。
