Florendo F T, Harmon H C
South Med J. 1979 Dec;72(12):1516-8.
The records of eight patients with aortoenteric fistulas from 1961 to 1976 were reviewed. The aortoenteric fistulas were primary in three patients and secondary in the remaining five. The most common symptom was gastrointestinal hemmorrhage, seen in seven of eight patients. Four patients also had fever. Seventy percent of patients survived more than 24 hours after the initial hemorrhage, allowing time for a rapid work-up. An algorithm is presented for evaluating a patient suspected of having an aortoenteric fistula. It is a work-up of exclusion and requires six to eight hours. The definitive diagnosis and management of the patient is accomplished by surgical exploration. Primary aortoenteric fistulas are best managed by aneurysmectomy and Dacron graft replacement. Management of secondary fistulas should be tailored to the condition of the patient at the time of operation. The preferred treatment consists of excision of the graft and extra-anatomic bypass. The operative mortality in this series was 25%.
回顾了1961年至1976年期间8例主动脉肠瘘患者的病历。其中3例为原发性主动脉肠瘘，其余5例为继发性。最常见的症状是胃肠道出血，8例患者中有7例出现此症状。4例患者还伴有发热。70%的患者在初次出血后存活超过24小时，这为快速检查提供了时间。本文提出了一种评估疑似主动脉肠瘘患者的算法。这是一种排除性检查，需要6至8小时。患者的明确诊断和治疗通过手术探查完成。原发性主动脉肠瘘最好通过动脉瘤切除术和涤纶人工血管置换术进行治疗。继发性瘘的治疗应根据手术时患者的情况进行调整。首选的治疗方法是切除人工血管并进行解剖外旁路移植。该系列的手术死亡率为25%。
