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Su un caso di fistola aorto-enterica primitiva

Fancellu, Alessandro and Giuliani, G. and Feo, Claudio F. and Scanu, Antonio Mario and Porcu, Alberto (2004) Su un caso di fistola aorto-enterica primitiva. Annali italiani di chirurgia, Vol. 75 (3), p. 373-378. ISSN 0003-469X. Article.

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Abstract

Primary aortoenteric fistulas (PAEF) are rare entities associated with a high mortality. Although several causes have been reported, their occurrence is usually due to erosion of an abdominal aortic aneurysm into the intestinal tract. The most common sites for the fistula are the third and fourth portions of duodenum. The classical triad of gastrointesti nal hemorrhage, abdominal mass and abdominal or back pain, though highly suggestive for PAEF, is uncommon. The typical bleeding pattern associated with PAEF is characteristically intermittent, starting with a brief “herald bleeding” followed eventually by major gastrointestinal hemorrhage, often with fatal outcome. The pre-operative examinations are often not helpful and can lead to delayed diagnosis and surgery. In a patient with risk factors for atherosclerosis and significant upper gastrointestinal bleeding in the absence of an evident source, PAEF should be suspected. A high index of suspicion of this condition allows correct diagnosis and definitive treatment to be carried out. If PAEF is suspected and the patient is unstable the surgeon should be prepared to skip the preoperative investigations in favour of early surgical exploration. Definitive treatment includes primary duodenal repair and aortic aneurismal resection with graft “in situ” replacement. The authors present a successfully treated case and stress the importance of clinical suspicion in order to achieve correct diagnosis and treatment.

Item Type:Article
ID Code:4847
Status:Published
Refereed:Yes
Uncontrolled Keywords:Aortointeric fistula, aneurysm, grastrointestinal hemorrhage, surgical treatment
Subjects:Area 06 - Scienze mediche > MED/18 Chirurgia generale
Divisions:001 Università di Sassari > 03 Istituti > Clinica medica generale e terapia medica
Publisher:Edizioni Luigi Pozzi
ISSN:0003-469X
Deposited On:16 Nov 2010 17:34

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