Voorhoeve R, Moll F L, de Letter J A, Bast T J, Wester J P, Slee P H
Department of surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Ann Vasc Surg. 1996 Jan;10(1):40-8. doi: 10.1007/BF02002340.
Primary aortoenteric fistula, a direct communication between the aorta and the intestinal tract, is a rare cause of gastrointestinal hemorrhage. Eight patients who were all treated at one hospital are described, followed by a review of all surgically treated patients reported within the past 10 years. The usual cause is erosion of an atherosclerotic aneurysm into the adherent duodenum, but a wide variety of other causes and localizations have been described. The clinical presentation is usually one of intermittent gastrointestinal hemorrhage resulting in lethal exsanguination within a matter of hours or days. Pain, a pulsatile abdominal mass, or fever may not be present. Endoscopy, arteriography, ultrasound, and CT scan can be useful in the evaluation of these patients, but physical examination and a high index of suspicion remain key to diagnosis. Primary aortoenteric fistula is more often discovered unexpectedly during exploratory laparotomy and is not usually considered as a presumptive preoperative diagnosis. Although contamination is unavoidable, most patients are treated with an in situ vascular graft and primary closure of the intestinal defect with good results.
原发性主动脉肠瘘是指主动脉与肠道之间的直接连通，是胃肠道出血的罕见原因。本文描述了在同一家医院接受治疗的8例患者，随后回顾了过去10年报告的所有接受手术治疗的患者。常见病因是动脉粥样硬化性动脉瘤侵蚀至粘连的十二指肠，但也有多种其他病因和发病部位的描述。临床表现通常为间歇性胃肠道出血，可在数小时或数天内导致致命性失血。可能不存在疼痛、搏动性腹部肿块或发热症状。内镜检查、动脉造影、超声和CT扫描对这些患者的评估可能有用，但体格检查和高度怀疑仍然是诊断的关键。原发性主动脉肠瘘更多是在剖腹探查术中意外发现，通常不作为术前推测性诊断。尽管污染不可避免，但大多数患者采用原位血管移植和肠道缺损一期缝合治疗，效果良好。
