Zarbaliyev Elbrus, Konukoğlu Oğuz, Çağlıkülekçi Mehmet, Mansuroğlu Denyan, Baş Serap, Kilercik Hakan
Department of General Surgery, Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Jul 26;29(3):399-403. doi: 10.5606/tgkdc.dergisi.2021.21518. eCollection 2021 Jul.
The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.
由于腹主动脉瘤导致的腹主动脉移植物数量增加，使得继发性主动脉肠瘘作为胃肠道出血的原因更为常见。对于出现从粪便潜血到大量胃肠道出血等临床症状并伴有失血性休克的患者，高度怀疑指数在诊断中起着重要作用。一名65岁男性患者连续发生了两例继发性主动脉肠瘘。第一例是主动脉移植物-空肠瘘，第二例是在短时间内出现的主动脉移植物-十二指肠瘘。继发性主动脉肠瘘发生在主动脉双股动脉旁路移植术后。患者接受了移植物修复和空肠修补术。三个月后，由于新出现的主动脉移植物-十二指肠瘘，患者再次接受手术。十二指肠缺损被修复，并进行了解剖外主动脉髂动脉旁路移植术以避免与移植物相关的肠瘘。患者术后顺利出院，术后九个月无任何并发症。
