Successful management of secondary aorto-enteric fistula: a case report from Nepal.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-01-31 eCollection Date: 2025-02-01 DOI:10.1097/MS9.0000000000002947
Uttam Chaulagain, Kailash Mani Pokhrel, Kapil Khanal, Bishal Gaurav, Prasan Bir Singh Kansakar, Uttam Krishna Shrestha
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Abstract

Introduction: Aorto-enteric fistulas (AEFs) are rare but serious causes of gastrointestinal bleeding, classified into primary and secondary types. This report describes the first documented case of a secondary AEF from Nepal, emphasizing the need for prompt diagnosis and surgical intervention.

Case presentation: A 36-year-old male presented with black tarry stools and abdominal pain, 7 years after aorto-right common femoral artery and aorto-left common iliac artery bypass surgery for common iliac artery occlusive disease. He had a history of recurrent graft infections. Examination revealed hypotension, tachycardia, and melena. Upper gastrointestinal endoscopy showed the aortic graft in the duodenum, with CECT confirming an aortic graft inside the bowel lumen, leading to a diagnosis of secondary aorto-enteric fistulas (SAEF).

Discussion: SAEFs often arise from graft infection and mechanical erosion by the pulsatile graft. Patients typically present with gastrointestinal bleeding, and early diagnosis is crucial, as untreated SAEFs have a mortality rate approaching 100%. The combined use of upper gastrointestinal endoscopy and CECT is essential for identifying and guiding the surgical intervention of SAEFs. This case underscores the importance of early diagnosis and early surgical intervention for successful management of SAEF.

Conclusion: This case highlights the importance of suspecting secondary AEFs in patients with aortic graft presenting with gastrointestinal bleeding. Early diagnosis and timely surgical intervention are essential for improving patient outcomes.

继发性腹肠瘘的成功治疗:尼泊尔1例报告。
主动脉肠瘘(AEFs)是一种罕见但严重的胃肠道出血原因,分为原发性和继发性。本报告描述了尼泊尔第一例记录在案的继发性急性心衰病例,强调了及时诊断和手术干预的必要性。病例介绍:一名36岁男性,因髂总动脉闭塞性疾病行主动脉-右股总动脉和主动脉-左髂总动脉搭桥手术7年后,出现黑色焦油样便和腹痛。他有复发性移植物感染史。检查发现低血压,心动过速,黑黑。上消化道内镜显示主动脉移植物位于十二指肠,CECT证实主动脉移植物位于肠腔内,诊断为继发性主动脉肠瘘(SAEF)。讨论:saf通常由移植物感染和搏动移植物的机械侵蚀引起。患者通常表现为胃肠道出血,早期诊断至关重要,因为未经治疗的saef死亡率接近100%。上消化道内窥镜和CECT的联合应用对于识别和指导saef的手术干预至关重要。这个病例强调了早期诊断和早期手术干预对成功治疗SAEF的重要性。结论:本病例强调了在以胃肠道出血为表现的主动脉移植患者中,怀疑继发性房颤的重要性。早期诊断和及时手术干预对改善患者预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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5.90%
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