Marine Leopoldo, Mertens Renato, Torrealba Ignacio, Valdés Francisco, Bergoeing Michel, Vargas Francisco, Yáñez Hugo
Departamento de Cirugía Vascular y Endovascular, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Med Chil. 2021 Jan;149(1):132-136. doi: 10.4067/S0034-98872021000100132.
Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
原发性主动脉肠瘘是主动脉腔与消化道某一部分之间的自发连通。最常见的原因是腹主动脉瘤侵蚀十二指肠第三或第四部分。其临床症状为胃肠道出血，体格检查时可有或无腹痛及搏动性腹部肿块。胃肠道出血起初为反复性且自限性，随后会发展为致命性的大出血。内镜检查仅能诊断出25%的主动脉肠瘘，因为这些瘘通常位于十二指肠远端。腹部和盆腔的对比计算机断层扫描仅在60%的病例中具有诊断价值。我们报告了三例这种疾病的病例。一名67岁男性，表现为上消化道出血。他接受了手术，发现主动脉瘤与十二指肠之间存在连通并进行了手术修复。患者情况良好。一名67岁男性，患有腹主动脉瘤，表现为腹痛。他接受了手术并进行了抗凝治疗。术后他出现了大量胃肠道出血，新的计算机断层扫描显示存在主动脉肠瘘，随后进行了手术修复。患者情况良好。一名82岁男性，患有腹主动脉瘤，表现为便血。计算机断层扫描显示动脉瘤与十二指肠第三部分之间存在连通，进行了手术修复。患者在术后第八天死亡。
