Veraldi Gian Franco, Minicozzi Anna Maria, Genco Bruno, De Luca Manuela, Pacca Rosario, Tasselli Sebastiano
I Divisione Clinicizzata di Chirurgia Generale, SSO Ospedaliera di Chirurgia Vascolare, Azienda Ospedaliero, Universitaria di Verona, Ospedale Civile Maggiore, Verona.
Chir Ital. 2008 Mar-Apr;60(2):273-7.
Primary aortoduodenal fistula is a serious and rare complication of abdominal aortic aneurysms. This life-threatening disease results most commonly from an abdominal aortic aneurysm, with the fistula forming between the aorta and the third or the fourth portions of the duodenum. Diagnosis is often difficult and urgent adequate surgical treatment as soon as possible is the only therapeutic option to save the lives of these patients. In this paper we report the case of a 76-year-old female admitted to our institution for massive haematemesis, melaena, severe hypotension and violent back pain. The urgent diagnostic work-up revealed an abdominal aortic aneurysm with a strong suspicion of duodenal fistulisation. The diagnosis was confirmed in the operating room, where the patient was immediately submitted to closure of the fistula and in situ aortic reconstruction using an aortic homograft. The postoperative course was uneventful and after 6 months the patient is doing well without any recurrence of infection.
原发性主动脉十二指肠瘘是腹主动脉瘤一种严重且罕见的并发症。这种危及生命的疾病最常见于腹主动脉瘤，瘘管形成于主动脉与十二指肠第三或第四部分之间。诊断往往困难，尽快进行紧急且充分的手术治疗是挽救这些患者生命的唯一治疗选择。本文报告了一例76岁女性患者，因大量呕血、黑便、严重低血压和剧烈背痛入住我院。紧急诊断检查发现腹主动脉瘤，高度怀疑十二指肠瘘形成。在手术室确诊后，患者立即接受瘘管闭合术，并使用主动脉同种异体移植物进行原位主动脉重建。术后过程顺利，6个月后患者情况良好，无任何感染复发。
