1/17. Primary aortoduodenal fistula.The aortoenteric fistula is a well-known but uncommon cause of gastrointestinal haemorrhage. It is usually secondary to previous reconstructive surgery of an abdominal aortic aneurysm. Primary aortoenteric fistula is a rare disorder which predominantly occurs in the duodenum. We report the case of a 76-year-old patient who presented with melaena and hypovolaemic shock due to a primary aortoduodenal fistula. Pathogenesis, diagnostic procedures and postmortem pathologic examination of this condition are discussed. The value of computed tomography in establishing the diagnosis is emphasized.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/17. Gastrointestinal mucormycosis complicated by arterio-enteric fistula in a patient with non-Hodgkin's lymphoma.Gastrointestinal mucormycosis is a rare, often fatal, systemic infection found predominantly in immunocompromised patients. We report a case of gastrointestinal mucormycosis in a 53-year-old female with non-Hodgkin's lymphoma. Following her first course of chemotherapy, bowel obstruction developed as a result of mucormycosis. Despite treatment with antifungal therapy, she required a laparotomy owing to severe haemorrhage caused by mucormycosal invasion of her iliac artery. With continued antifungal treatment and further chemotherapy, she ultimately underwent reversal of her Hartmann's procedure and remains disease-free.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/17. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm.A 74-year-old male patient was operated in Vakif Gureba Hospital for aortoduodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and computed tomography in another center. Appearing of melena and hematemesis gastroduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the patient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal abdominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnected. Following aneurysmotomy a prosthetic graft was placed in the aortobiiliac position. The patient was discharged at the 42nd postoperative day. Primary aortoenteric fistula is a very rare consequence of untreated abdominal aortic aneurysm. The segments of intestine most frequently involved in aortoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical presentation is recurrent episodes of gross gastrointestinal haemorrhage. These cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
4/17. Primary aortoenteric fistula: report of six new cases.Primary aortoenteric fistula (PAEF) is defined as a communication between the native aorta and the gastrointestinal tract, in contrast to secondary fistulas, which arise between a suture line of a vascular graft and the intestine. arteriosclerosis is the predominant cause of PAEF and accounts for more than two-thirds of the cases reported. The pathogenesis is usually based on direct adhesion of a segment of the gastrointestinal tract to an aortic aneurysm, followed by progressive erosion through the bowel wall. The clinical presentation is usually one of intermittent gastrointestinal haemorrhage resulting in lethal exsanguination. pain in the abdomen, a pulsatile abdominal mass or fever may be present. The choice of various diagnostic procedures is often decided by the clinical presentation. Esophagogastroduodenoscopy, ultrasound and CT scan may be useful in the evaluation of these patients. Current recommendations for repair include debridement of the aneurysmal aorta, repair with an in situ graft and primary repair of the gastrointestinal tract, followed by aggressive antimicrobial therapy. We present six cases of PAEF surgically treated at the St. Radboud Hospital, the Canisius Wilhelmina Hospital in Nijmegen and the Lukas Hospital in Apeldoorn over a period of 15 years.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
5/17. Aortoduodenal fistula following aortobifemoral bypass.A patient with a fistula between the aortic graft and the third portion of the duodenum was admitted in our institution and submitted to surgery that involved extra anatomical axillobifemoral bypass, prosthesis removal and bowel resection with a gastrojejunal Roux anastomosis. A prosthetic fistula after aortic surgery is a rare but potentially fatal complication. Erosion, infection and pseudoaneurysm are mechanisms in the pathogenesis of aortoenteric fistula. Because of the high mortality and morbidity, associated with secondary aortoenteric fistula, surgical treatment is always recommended. A combination of endoscopy and CT or MRI may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion. An aortoenteric fistula should always be suspected in all patients who have undergone aortic graft surgery and present with gastrointestinal haemorrhage. The authors discuss the modern management of this challenging complication of aortic surgery.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
6/17. Arterioenteric fistulae: diagnosis and treatment by angiography.Two cases of massive gastrointestinal haemorrhage caused by arterioenteric fistulae are presented. In both cases, bleeding was controlled by interventional angiography. In the first case, a fistula between an aberrant right subclavian artery and a reconstructed oesophagus was temporarily occluded with a balloon catheter as a pre-surgical measure. In the second case a communication between the external iliac artery and the colon in a patient with invasive cervical cancer was treated by embolization. An arterioenteric fistula should be considered as a possible cause of acute gastrointestinal haemorrhage in post-operative or cancer patients and aortography or pelvic arteriography may be required to make the diagnosis.- - - - - - - - - - ranking = 2keywords = haemorrhage (Clic here for more details about this article) |
7/17. Fistulisation of an iliac pseudoaneurysm into the appendix. Presentation of a case and a review of the literature.A case of ilioappendiceal fistula is presented. The patient had previously been operated on for a ruptured aneurysm of the common iliac artery. 21 years later he developed occult gastrointestinal bleeding without signs of infection. colonoscopy revealed bloody faeces and an isotope scan haemorrhage in the ascending colon. laparotomy and right hemicolectomy was performed without identifying the fistula. The head of the appendix was left attached to the scarred peritoneal wall. As the bleeding continued, a second laparotomy was performed revealing an iliac pseudoaneurysm with fistulisation into the head of the appendix. Vascular reconstruction was attempted, but the patient succumbed to massive bleeding on the operating table.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
8/17. Colonoscopic diagnosis of an aorto-appendiceal fistula.A case of an aorto-appendicular, aorto-enteric fistula diagnosed by colonoscopy after presentation with colonic haemorrhage is reported. The role of colonoscopy in such patients is discussed and reported experience is reviewed.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
9/17. Major gastrointestinal haemorrhage as a complication of cholecystoduodenal fistula in gallstone disease. Report of three cases.Three patients with cholecystoduodenal fistulae due to gallstone penetration, resulting in major gastrointestinal haemorrhage are presented. diagnosis and treatment of this condition are discussed.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
10/17. Arterio-intestinal fistula as a complication following insertion of an aorto-iliac bifurcation graft. A case report.A patient who had been treated with insertion of an aorto-iliac bifurcation dacron prosthesis for atherosclerosis 6 years previously, developed a fistulous communication between a false aneurysm at the distal anastomosis to the left iliac artery and an ileal loop. Intestinal haemorrhage and signs of infection were the main symptoms. Successful surgical treatment consisted of suturing the intestinal defect, removal of the left limb of the graft and vascular reconstruction by means of a subcutaneous femorofemoral vein bypass.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
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