Mackenzie David C
Department of Emergency Medicine, Maine Medical Center, Portland, Maine.
J Emerg Med. 2015 Jun;48(6):699-701. doi: 10.1016/j.jemermed.2015.01.003. Epub 2015 Mar 18.
Aortoenteric fistula is a rare but serious cause of gastrointestinal bleeding. Early diagnosis and definitive treatment with fistula repair may improve patient outcomes. We report the use of point-of-care ultrasound to identify an aortoenteric fistula in a patient presenting with abdominal pain and shock.
A 78-year old man presented to the Emergency Department with abdominal pain and 5 days of minimal hematochezia. He was hypotensive and had diffuse abdominal tenderness. Point-of-care ultrasound was performed, demonstrating an abdominal aortic aneurysm with a hypoechoic projection into a segment of bowel abutting the aorta. Color flow was present through the structure, consistent with an aortoenteric fistula. After resuscitation with red blood cells, computed tomography was performed to confirm the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinical ultrasound has a well-established role in the detection of aortic aneurysm. This case illustrates that point-of-care ultrasound can also be used to rapidly identify an aortoenteric fistula and expedite timely care and surgical evaluation.
主动脉肠瘘是胃肠道出血的一种罕见但严重的病因。早期诊断并通过瘘管修复进行确定性治疗可能改善患者预后。我们报告了在一名出现腹痛和休克的患者中使用床旁超声来识别主动脉肠瘘的情况。
一名78岁男性因腹痛和5天少量便血就诊于急诊科。他血压低，全腹压痛。进行了床旁超声检查，显示腹主动脉瘤，有一个低回声突出物延伸至紧邻主动脉的一段肠管。该结构有血流信号，符合主动脉肠瘘表现。输注红细胞复苏后，进行了计算机断层扫描以确诊。
急诊医生为何应了解此情况？：临床超声在主动脉瘤检测中具有公认的作用。本病例表明，床旁超声还可用于快速识别主动脉肠瘘，并加快及时治疗和手术评估。
