Miyamoto Kokichi, Inaba Mototaka, Kojima Toru, Niguma Takefumi, Mimura Tetsushige
Department of Surgery, Japan.
Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, kita-ku, Okayama 7008511, Japan.
Int J Surg Case Rep. 2016;25:234-7. doi: 10.1016/j.ijscr.2016.06.010. Epub 2016 Jun 29.
Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after aortic reconstruction. Although a number of reports describing treatments for SADF have been published, the optimal management is unclear. A review of the literature suggested methods of reconstruction, control of bleeding, and reduction of infection in the management of SADF. The most important factor for acute intervention is controlling the bleeding from the fistula. We report one case treated using intra-aortic balloon occlusion (IABO) for SADF.
We describe a case of secondary aortoduodenal fistula that occurred seven years following aortobifemoral reconstruction for abdominal aortic aneurysm.
Early control of bleeding is essential for survival of the patient. Emergency laparotomy or endovascular stenting frequently have been chosen as interventions, although each approach has significant limitations. Emergency laparotomy for patients with hemodynamic instability may create excessive physiologic stress, and endovascular stenting may not be available at every surgical facility. The use of IABO for cases of intraperitoneal bleeding due to trauma has been previously described. IABO is relatively easy to implement, and enabled us to control the bleeding from the aorta more rapidly than other strategies.
Based on a review of the literature and our own experience, IABO should be considered as one option for the management of SADF.
继发性主动脉十二指肠瘘（SADF）是主动脉重建术后一种罕见但危及生命的并发症。尽管已经发表了许多描述SADF治疗方法的报告，但最佳治疗方案仍不明确。文献综述提出了SADF治疗中重建方法、出血控制和感染减少的相关内容。急性干预的最重要因素是控制瘘口出血。我们报告一例使用主动脉内球囊阻断术（IABO）治疗SADF的病例。
我们描述一例腹主动脉瘤行主动脉双股动脉重建术后7年发生继发性主动脉十二指肠瘘的病例。
早期控制出血对患者生存至关重要。紧急剖腹手术或血管内支架置入术常被选作干预措施，尽管每种方法都有显著局限性。对于血流动力学不稳定的患者，紧急剖腹手术可能会产生过度的生理应激，而且并非每个手术机构都能进行血管内支架置入术。此前已有关于IABO用于治疗创伤性腹腔内出血病例的描述。IABO相对易于实施，且使我们能够比其他策略更快地控制主动脉出血。
基于文献综述和我们自己的经验，IABO应被视为SADF治疗的一种选择。
