Marolt Urska, Potrc Stojan, Bergauer Andrej, Arslani Nuhi, Papes Dino
Department of Surgery, University Clinical Center Maribor, Maribor, Slovenia.
Department of Vascular Surgery, University Clinical Center Maribor, Maribor, Slovenia.
Acta Clin Croat. 2013 Sep;52(3):363-8.
Secondary aortoenteric fistulas (SAEF) are a relatively rare but dangerous complication of aortal reconstructive surgery. We present a patient that underwent aortobifemoral bypass three years before developing the signs of aortoenteric fistula, and we reviewed the literature on the topic. Since the clinical signs are nonspecific, physicians should have a high index of suspicion for SAEF in patients who underwent aortal reconstructive surgery. The most useful diagnostic tools for stable patients are upper gastrointestinal endoscopy and computed tomography scan with contrast that can, in combination with history and clinical signs, enable accurate diagnosis in more than 90% of patients. Unstable patients with suspected aortoenteric fistula should undergo exploratory laparotomy. The treatment of choice is open surgery with graft excision, wide debridement of infected tissue, bowel repair or resection followed by an extra-anatomic bypass or in situ placement of a new graft. Early postoperative mortality remains high, around 30% in most analyses. Currently there are no guidelines for the diagnosis and management of SAEF, so individualized approach is necessary for each patient.
继发性主动脉肠瘘（SAEF）是主动脉重建手术中一种相对罕见但危险的并发症。我们报告了一名患者，该患者在出现主动脉肠瘘体征三年前接受了主动脉双股动脉旁路移植术，并对该主题的文献进行了回顾。由于临床体征不具有特异性，对于接受过主动脉重建手术的患者，医生应高度怀疑SAEF。对于病情稳定的患者，最有用的诊断工具是上消化道内镜检查和增强计算机断层扫描，结合病史和临床体征，能够在90%以上的患者中实现准确诊断。疑似主动脉肠瘘的不稳定患者应接受剖腹探查术。首选的治疗方法是开放手术，包括切除移植物、广泛清创感染组织、修复或切除肠道，随后进行解剖外旁路移植或原位植入新的移植物。术后早期死亡率仍然很高，大多数分析显示约为30%。目前尚无SAEF的诊断和管理指南，因此对每个患者都需要采取个体化方法。
