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Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula

INTRODUCTION: Primary aorto-enteric fistula (AEF) is an uncommon life-threating condition. Only 4% of them involve the jejunum or ileum and its mortality ranges from 33 to 85%. PRESENTATION OF CASE: A 54-year-old female was admitted to the Emergency Department with syncope and hematemesis. The esoph...

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Autores principales: Fernández de Sevilla, Elena, Echeverri, Juan Andrés, Boqué, Miriam, Valverde, Silvia, Ortega, Nuria, Gené, Anna, Rodríguez, Nivardo, Balibrea, José María, Armengol, Manel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353932/
https://www.ncbi.nlm.nih.gov/pubmed/25616071
http://dx.doi.org/10.1016/j.ijscr.2015.01.010
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author Fernández de Sevilla, Elena
Echeverri, Juan Andrés
Boqué, Miriam
Valverde, Silvia
Ortega, Nuria
Gené, Anna
Rodríguez, Nivardo
Balibrea, José María
Armengol, Manel
author_facet Fernández de Sevilla, Elena
Echeverri, Juan Andrés
Boqué, Miriam
Valverde, Silvia
Ortega, Nuria
Gené, Anna
Rodríguez, Nivardo
Balibrea, José María
Armengol, Manel
author_sort Fernández de Sevilla, Elena
collection PubMed
description INTRODUCTION: Primary aorto-enteric fistula (AEF) is an uncommon life-threating condition. Only 4% of them involve the jejunum or ileum and its mortality ranges from 33 to 85%. PRESENTATION OF CASE: A 54-year-old female was admitted to the Emergency Department with syncope and hematemesis. The esophagogastroduodenoscopy found a pulsatile vessel in the second portion of the duodenum. A computed tomography scan showed an AEF with an infrarenal aortic aneurysm and iliac artery thrombosis. During surgery, an infrarenal aortic aneurysm complicated with an aorto-jejunal fistula was found. An axilo-bifemoral bypass, open repair of the aneurysm and segmental small bowel resection with primary suture of the jejunal defect were performed. DISCUSSION: Depending on previous aortic grafting, AEF can be classified as primary or secondary. Primary AEF is usually caused by an untreated abdominal aortic aneurysm, commonly presenting an infectious etiology. The main clinical sign is a “herald” hemorrhage. The EGD is considered as the first step in diagnosing AEF. The treatment of choice for AEF is emergent surgery. Use of broad-spectrum antibiotics is mandatory in the postoperative period to avoid fistula recurrence. CONCLUSION: AEF is a rare entity with a high mortality. High clinical suspicion is essential to make a correct diagnosis, which is crucial for the prognosis of these patients, such is the case of our patient. If hemodynamic stability is achieved, it allows to employ surgical strategies in which extra-abdominal bypass is performed before fistula is treated.
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spelling pubmed-43539322015-03-31 Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula Fernández de Sevilla, Elena Echeverri, Juan Andrés Boqué, Miriam Valverde, Silvia Ortega, Nuria Gené, Anna Rodríguez, Nivardo Balibrea, José María Armengol, Manel Int J Surg Case Rep Case Report INTRODUCTION: Primary aorto-enteric fistula (AEF) is an uncommon life-threating condition. Only 4% of them involve the jejunum or ileum and its mortality ranges from 33 to 85%. PRESENTATION OF CASE: A 54-year-old female was admitted to the Emergency Department with syncope and hematemesis. The esophagogastroduodenoscopy found a pulsatile vessel in the second portion of the duodenum. A computed tomography scan showed an AEF with an infrarenal aortic aneurysm and iliac artery thrombosis. During surgery, an infrarenal aortic aneurysm complicated with an aorto-jejunal fistula was found. An axilo-bifemoral bypass, open repair of the aneurysm and segmental small bowel resection with primary suture of the jejunal defect were performed. DISCUSSION: Depending on previous aortic grafting, AEF can be classified as primary or secondary. Primary AEF is usually caused by an untreated abdominal aortic aneurysm, commonly presenting an infectious etiology. The main clinical sign is a “herald” hemorrhage. The EGD is considered as the first step in diagnosing AEF. The treatment of choice for AEF is emergent surgery. Use of broad-spectrum antibiotics is mandatory in the postoperative period to avoid fistula recurrence. CONCLUSION: AEF is a rare entity with a high mortality. High clinical suspicion is essential to make a correct diagnosis, which is crucial for the prognosis of these patients, such is the case of our patient. If hemodynamic stability is achieved, it allows to employ surgical strategies in which extra-abdominal bypass is performed before fistula is treated. Elsevier 2015-01-09 /pmc/articles/PMC4353932/ /pubmed/25616071 http://dx.doi.org/10.1016/j.ijscr.2015.01.010 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
spellingShingle Case Report
Fernández de Sevilla, Elena
Echeverri, Juan Andrés
Boqué, Miriam
Valverde, Silvia
Ortega, Nuria
Gené, Anna
Rodríguez, Nivardo
Balibrea, José María
Armengol, Manel
Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title_full Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title_fullStr Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title_full_unstemmed Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title_short Life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
title_sort life-threating upper gastrointestinal bleeding due to a primary aorto-jejunal fistula
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353932/
https://www.ncbi.nlm.nih.gov/pubmed/25616071
http://dx.doi.org/10.1016/j.ijscr.2015.01.010
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