A complicated case of primary aortojejunal fistula: A case report.
| Autor: | Rezaei H; Department of Surgery, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran., Ghasemi F; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: farniaghasemi@sums.ac.ir., Johari HG; Thoracic and Vascular Surgery Research center, Shiraz University of Medical Sciences, Shiraz, Iran., Gholami MA; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. |
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| Jazyk: | angličtina |
| Zdroj: | International journal of surgery case reports [Int J Surg Case Rep] 2024 Jul; Vol. 120, pp. 109842. Date of Electronic Publication: 2024 Jun 01. |
| DOI: | 10.1016/j.ijscr.2024.109842 |
| Abstrakt: | Background: Aortoenteric fistulas are rare and life-threatening pathology characterized by an abnormal connection between the aorta and the gastrointestinal tract. Case Presentation: The patient is a 61-year-old male who initially presented with hypogastric pain, hematemesis, and melena. Computed tomography angiography (CTA) revealed an abdominal aorta aneurysm but not a fistula. Imaging modalities were inconclusive in the diagnosis. The patient became unstable hemodynamically and was transferred to the operation room. The definitive diagnosis of aortoenteric fistula was confirmed during surgical exploration. Urgent surgery was performed; however, the patient experienced a cascade of complications, including rebleeding, intestinal leakage, and hemodynamic instability due to aortic bleeding. Despite rigorous interventions, the patient expired due to multiple organ failure 53 days after the first repair surgery. Clinical Discussion: There is no definite imaging method due to the lack of guidelines, and the absence of exact findings has led to intraoperative diagnosis in up to 50 % of cases. This is one of the modalities of choice to examine suspected aortoenteric fistulas. Many authors prefer Computed tomography (CT) with intravenous contrast for suspected AEF despite its limitations in clarity. Others recommend CT angiography as the preferred modality. It is worth noting that, as reported in a comprehensive retrospective review, the mortality rate is approximately 46 % within 60 days after AEF repair surgery. Conclusion: This report adds to the limited data about primary aortojejunal fistulas, an extremely rare type of aortoenteric fistulas which has been reported in only a few cases. Understanding the importance of promptly suspecting, diagnosing, and intervening is crucial, emphasizing the importance of sharing such cases for medical guidance and better patient outcomes. Competing Interests: Conflict of interest statement None. (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| Databáze: | MEDLINE |
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