Simó Alari Francesc, Molina González Esther, Gutierrez Israel, Ahamdanech-Idrissi Aïcha
General surgery, Centre Hospitalier de la val d'Ariege, Foix, France.
Intensive Care Medicine, Centre hospitalier du val d'Ariege, Foix, France.
BMJ Case Rep. 2017 Oct 20;2017:bcr-2017-220186. doi: 10.1136/bcr-2017-220186.
A 65-year-old man with history of aortobifemoral surgery 4 years ago was admitted to hospital after sudden abdominal pain. Initially misdiagnosed as renal colic, he was treated with analgesics, and while on observation he started with haematemesis, rapidly responding to volume infusion. Upper gastrointestinal endoscopy showed fresh blood in the stomach with no visible active bleeding. CT scan showed an important contrast extravasation from the aorta to the third duodenal portion, restarting haemodynamic instability and a cardiac arrest. Cardiopulmonary resuscitation (CPR) manoeuvres followed by intense fluid resuscitation and urgent laparotomy with a fast transabdominal supracoeliac aortic clamping was performed. After multiple blood and plasma unit transfusion and intravenous norepinephrine, two more cardiac arrests were recovered. Unfortunately, after aggressive management, the patient rapidly deteriorated and deceased on the table. Aortoduodenal fistula is a rare entity causing life-threatening bleeding. Its diagnosis requires high clinical suspicion and surgery offers the only hope for survival.
一名65岁男性，4年前接受过主动脉双股动脉手术，因突发腹痛入院。最初被误诊为肾绞痛，接受了镇痛治疗，在观察期间开始出现呕血，经补液后迅速好转。上消化道内镜检查显示胃内有新鲜血液，但未见明显活动性出血。CT扫描显示从主动脉到十二指肠第三段有大量造影剂外渗，再次出现血流动力学不稳定并发生心脏骤停。随后进行了心肺复苏操作，接着进行了积极的液体复苏，并紧急剖腹手术，快速经腹进行腹腔干上方主动脉钳夹。在多次输注血液和血浆以及静脉注射去甲肾上腺素后，又恢复了两次心脏骤停。不幸的是，经过积极治疗，患者病情迅速恶化，在手术台上死亡。主动脉十二指肠瘘是一种罕见的导致危及生命出血的疾病。其诊断需要高度的临床怀疑，手术是生存的唯一希望。
