Gastroenterology Medicine Center, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
BMC Gastroenterol. 2021 Feb 1;21(1):45. doi: 10.1186/s12876-021-01616-9.
Upper gastrointestinal (GI) bleeding is the most important presentation of an aorto-duodenal fistula (ADF). Early diagnosis is difficult, and the disease is associated with high mortality. The present study aimed to examine the clinical and the endoscopic characteristics of ADF in eight patients who presented to our hospital. We also sought to clarify the diagnostic approach towards the disease.
The present study examined the clinical and the endoscopic/computed tomography (CT) characteristics of ADF in eight patients who were definitively diagnosed with this condition in a 12-year period at our hospital.
The patients comprised of five men and three women, with a mean age of 69.8 years. Upper gastrointestinal bleeding was the chief complaint for all the patients. Out of these, two patients presented with shock. The patients' mean haemoglobin at presentation was 7.09 g/dL, and the mean number of blood transfusions was 7.5. All patients had undergone intervention to manage an aortic pathology in the past. As the first investigation, an upper GI endoscopy in 5 and a CT scan in 3 patients were performed. In cases where CT scan was performed first, no definitive diagnosis was obtained, and the diagnosis was confirmed by performing an upper GI endoscopy. In cases where endoscopy was performed first, definitive diagnosis was made in only one case, and the other cases were confirmed by the CT scan. In some cases, tip attachments, converting to long endoscopes, and marking clips were found useful.
In patients who have undergone intervention to manage an aortic pathology and have episodes of upper gastrointestinal bleeding, ADF cannot be definitively diagnosed with only one investigation. In addition, when performing upper GI endoscopy in cases where an ADF is suspected, tip attachment, converting to a long endoscope, and using marking clips can be helpful.
上消化道（GI）出血是主动脉-十二指肠瘘（ADF）的最重要表现。早期诊断困难，且该疾病与高死亡率相关。本研究旨在检查 8 例因该疾病就诊于我院患者的临床和内镜特征。我们还试图阐明针对该疾病的诊断方法。
本研究检查了 8 例在我院确诊为该疾病的患者的临床和内镜/计算机断层扫描（CT）特征。这些患者在 12 年的时间内接受了检查。
这些患者包括 5 名男性和 3 名女性，平均年龄为 69.8 岁。所有患者均以上消化道出血为主诉。其中 2 例患者出现休克。患者就诊时的平均血红蛋白为 7.09g/dL，平均输血 7.5 次。所有患者过去均接受过主动脉病变的干预治疗。作为初次检查，5 例患者进行了上消化道内镜检查，3 例患者进行了 CT 扫描。在首先进行 CT 扫描的病例中，未获得明确诊断，通过进行上消化道内镜检查确诊。在首先进行内镜检查的病例中，仅 1 例确诊，其他病例通过 CT 扫描确诊。在某些情况下，尖端附件、转换为长内镜和标记夹被发现有用。
在接受过主动脉病变干预治疗且有上消化道出血发作的患者中，仅通过一项检查无法明确诊断 ADF。此外，在怀疑存在 ADF 时进行上消化道内镜检查，尖端附件、转换为长内镜和使用标记夹可能会有所帮助。
