Bacourt F, Lauru Y
Nouv Presse Med. 1979 Jun 23;8(28):2329-33.
Three types of aorto-intestinal fistula may be associated with gastrointestinal bleeding: primary fistulae from an aneurysm, secondary fistulae related to an aorto-prosthetic anastomosis and paraprosthetic fistulae by intraduodenal protrusion of a graft. The prevalence of secondary and paraprosthetic fistulae increases with more widespread vascular surgery. Only if the diagnosis is always borne in mind in a patient with an aneurysm or an aortic prosthesis makes it possible to recognise an aorto-intestinal fistula in time. Upper GI series and endoscopy are more useful in reaching a diagnosis than arteriography but signs must be sought in the third and fourth parts of the duodenum. The lesion may even be missed on surgical exploration, being concealed before separation of the aorta and duodenum. Infection and the underlying general medical condition are factors in the gravity of the operative prognosis. One of our three patients treated surgically was saved by the insertion of an extra-anatomic bypass. The prognosis in paraprosthetic fistulae, the possible precursor stage of a secondary aorto-digestive fistula, is more favourable.
三种类型的主动脉-肠瘘可能与胃肠道出血相关：动脉瘤引起的原发性瘘、与主动脉-人工血管吻合相关的继发性瘘以及移植物十二指肠内突出导致的人工血管旁瘘。随着血管外科手术的更广泛开展，继发性瘘和人工血管旁瘘的发生率有所增加。只有始终牢记动脉瘤或主动脉人工血管患者的诊断，才有可能及时识别主动脉-肠瘘。上消化道造影和内镜检查在诊断方面比动脉造影更有用，但必须在十二指肠第三和第四部分寻找体征。病变甚至可能在手术探查时被遗漏，在主动脉和十二指肠分离之前被隐藏。感染和潜在的全身健康状况是手术预后严重程度的因素。我们三名接受手术治疗的患者中有一名通过插入解剖外旁路得以挽救。人工血管旁瘘作为继发性主动脉-消化道瘘的可能前驱阶段，其预后更为有利。
