Antinori C H, Andrew C T, Santaspirt J S, Villanueva D T, Kuchler J A, deLeon M L, Cody W C, DiPaola D J, Manuele V J
Surgical Group of South Jersey, P.A., Cherry Hill, New Jersey, USA.
Am Surg. 1996 May;62(5):344-9.
Aortoenteric fistulas represent a life-threatening complication of abdominal aortic surgery that is becoming increasingly well-recognized. The presentation is often subtle, with a herald bleed followed by a period of grace, followed by an exsanguinating hemorrhage, and resulting in cardiovascular collapse. The diagnosis is often difficult, even with modern modalities of endoscopy, arteriography, and CAT scanning. A high index of suspicion is critical for making a successful diagnosis. The fistulas most commonly occur between the proximal aortic suture line and the duodenum after abdominal aortic surgery for aneurysmal or occlusive disease. Typically they occur years after this procedure. However, over the last several years, we have seen 12 cases with extremely unusual presentations that illustrate the wide spectrum of possible presentations. Included in this group was a primary aortoduodenal fistula, and two fistulas occurring just months after the initial surgery. These cases are reported with attention to the details of the presentation to emphasize the wide range of presentations of this serious complication. A brief review of this literature is also included in the report.
主动脉肠瘘是腹主动脉手术中一种危及生命的并发症，现在越来越受到广泛认识。其表现往往较为隐匿，先是有先兆性出血，随后有一段缓解期，接着是致命性大出血，最终导致心血管衰竭。即使采用现代的内镜检查、动脉造影和计算机断层扫描等手段，诊断往往也很困难。高度的怀疑指数对于成功诊断至关重要。瘘管最常发生在腹主动脉瘤或闭塞性疾病手术后，主动脉近端缝合线与十二指肠之间。通常在手术后数年出现。然而，在过去几年中，我们遇到了12例表现极为不寻常的病例，这些病例展示了可能出现的广泛临床表现。这组病例包括一例原发性主动脉十二指肠瘘，以及两例在初次手术后仅数月就出现的瘘管。本文报告这些病例，并关注其临床表现细节，以强调这种严重并发症的广泛表现形式。报告中还包括对该文献的简要综述。
