Department of Oncology, Surgical Oncology and Digestive Surgery, San Luigi University Hospital, University of Turin, Orbassano, Turin, Italy.
Department of Radiology, San Luigi University Hospital, University of Turin, Orbassano, Turin, Italy.
Ann Vasc Surg. 2021 May;73:561-565. doi: 10.1016/j.avsg.2020.12.056. Epub 2021 Feb 5.
Primary aorto-duodenal fistula (PADF) is a rare but life-threatening condition that should be taken into account when considering upper gastrointestinal bleeding in elderly patients with history of abdominal aortic aneurysm. Unfortunately, its diagnosis is often unsuspected until surgery or at postmortem.
We report a case of a 69 years old man with massive gastrointestinal bleeding secondary to a primary aortic duodenal fistula without a history of abdominal aortic aneurysm and with a misleading diagnosis of chronic ischemic enteritis. Repeated endoscopies and a prior CT angiography failed to document a proper diagnosis. Finally, the aorto-duodenal fistula was identified with a further abdominal CT angiography. Despite a prompt endovascular treatment with aortic endoprosthesis placement, the patient died due to a severe hemorrhagic shock consequent to the massive blood loss.
Primary aorto-duodenal fistula represents a very rare (<0.1% of incidence) cause of severe upper gastrointestinal bleeding most often leading to patient's death for hemorrhagic shock. It is frequently associated to aortic atherosclerosis. Its prompt diagnosis with endoscopy and CT angiography is very often difficult and almost never immediate. Furthermore, these exams may be misleading. In case of massive upper GI bleeding without a certain diagnosis in patients with severe aortic atherosclerosis, laparotomy with careful inspection of the distal duodenum is strongly recommended for aortic repair and bowel suture.
The diagnosis of PADF should be taken into account in patients with upper gastrointestinal bleeding associated with aortic atherosclerosis with strong suspect of penetrating ulcer.
原发性主动脉-十二指肠瘘（PADF）是一种罕见但危及生命的疾病，当考虑到有腹主动脉瘤病史的老年患者出现上消化道出血时，应将其纳入考虑范围。不幸的是，其诊断通常直到手术或尸检时才被怀疑。
我们报告了一例 69 岁男性患者，因原发性主动脉-十二指肠瘘导致大量胃肠道出血，无腹主动脉瘤病史，误诊为慢性缺血性肠炎。反复进行内镜检查和之前的 CT 血管造影术都未能确诊。最终，进一步的腹部 CT 血管造影术确定了该患者患有主动脉-十二指肠瘘。尽管及时进行了血管内治疗，放置了主动脉覆膜支架，但由于大量失血导致的严重失血性休克，患者最终死亡。
原发性主动脉-十二指肠瘘是一种非常罕见的（<0.1%的发生率）严重上消化道出血原因，常导致患者因失血性休克而死亡。它常与主动脉粥样硬化有关。通过内镜和 CT 血管造影术进行及时诊断通常非常困难，几乎从未能立即诊断。此外，这些检查可能会产生误导。对于有严重主动脉粥样硬化的患者，出现无明确诊断的大量上消化道出血时，强烈建议进行剖腹探查，并仔细检查十二指肠远端，以便进行主动脉修复和肠道缝合。
对于伴有主动脉粥样硬化且强烈怀疑穿透性溃疡的上消化道出血患者，应考虑 PADF 的诊断。
