Primary aortoduodenal fistula without abdominal aortic aneurysm

Jaroch, Mark T.; Diehl, James T.; Zippert, Albert M.

doi:10.3949/ccjm.52.4.579

Cited by 11 publications

(9 citation statements)

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“…Der direkte Nachweis einer aortoenteralen Fistel mittels Gastroduodenoskopie ist selten. Das Fehlen einer aktiven Blutungsquelle im Magen und im oberen Duodenum kann jedoch ein Hinweis auf eine aortoenterale Fistel sein.Allerdings kann das gleichzeitige Vorliegen anderer Blutungsursachen wie Gastritis, Duodenitis, Mallory-Weiss-Blutung oder Ulcus ventriculi zu Fehldiagnosen und einer möglicherweise lebensbedrohlichen Verzögerung der chirurgischen Intervention führen [12,16,41]. Die Computertomographie ist bei klinisch stabilen Patienten in manchen Fällen hilfreich.…”

Section: Diagnoseunclassified

“…Ohne chirurgische Intervention ist der Verlauf der Blutung immer letal [7]. In den meisten Fällen ist zur sicheren Identifizierung der Fistel die ausgiebige Mobilisierung des Duodenums erforderlich [16].…”

Section: Therapieunclassified

“…15% der Fälle ein positiver Keimnachweis gelingt, ist die primäre Anwendung extraanatomischer Bypassverfahren insbesondere vor dem Hintergrund einer deutlich höheren Morbidität und Mortalität nicht gerechtfertigt [7,34,40]. Ihre Anwendung sollte sich auf bestehende schwere Infektion im Bereich des Retroperitoneums beschränken [16].…”

Section: Therapieunclassified

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Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Drognitz

Pfeiffenberger

Schareck

et al. 2002

Chirurg

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Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

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Section: Diagnoseunclassified

Section: Therapieunclassified

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Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Drognitz

Pfeiffenberger

Schareck

et al. 2002

Chirurg

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“…Uncommon causes of PADF include carcinoma of the pancreas [14], biliary stones [15], trauma [16], ingested foreign bodies [17], peptic ulcer disease [18], benign cysts [19] and duodenal diverticular disease [20]. Four cases of idiopathic PADF are reported [21, 22, 23, 24], while seven cases of PADF following abdominal radiotherapy for malignancy are described in the medical literature [25, 26, 27, 28, 29, 30, 31]. We report a case of PADF developfing 25 years after surgery and radiotherapy and successfully treated at our institution.…”

Section: Introductionmentioning

confidence: 99%

Primary Aorto-Duodenal Fistula as a Late Complication of Radiotherapy: Report of a Case and Review of the Literature

Puccio

Pandolfo²,

Chiodini³

et al. 2008

Case Rep Gastroenterol

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Primary aorto-duodenal fistula (PADF) is a rare condition that may result in rapid exsanguination if untreated. PADF due to radiotherapy appears to be extremely rare with only a few cases reported in the medical literature. We report the case of a 61-year-old man who presented with massive gastrointestinal bleeding 25 years after surgery and radiotherapy for seminoma of the testicle and was successfully treated at our institution. We also review the literature on this very uncommon condition. A Medline search was conducted for the period from 1966 to June 2006 to identify case reports of PADF following radiotherapy. Only 7 cases of PADF due to radiotherapy were identified in addition to our own, 4 males and 3 females, aged 40 to 73 years, all treated for various forms of abdominal malignancies. The latency period ranged from 2 weeks to 25 years. None of the aortas were aneurysmatic. One patient died before he could be taken to the operating room. 5 patients underwent surgical repair and 4 survived. 2 patients underwent endovascular treatment but did not survive. PADF may develop up to 25 years after radiotherapy. Diagnosis should be considered when massive upper gastrointestinal bleeding develops in a patient who had previous abdominal radiotherapy, no matter how long before the episode of bleeding. Prompt surgical repair offers a reasonable chance of cure. Endovascular procedures do not appear to be efficacious.

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“…[3][4][5][6][7][8] Tuberculosis, syphilis, and other bacterial agents can lead to a primary aortoduodenal fistula, but the most common cause today is an atherosclerotic aneurysm that erodes into the duodenum. Surgical therapy, while mandatory, carries a very high mortality and morbidity primarily because of the difficulty and delay in establishing the diagnosis.9 This case report emphasizes the importance of establishing a preoperative diagnosis by computed tomog¬ raphy (CT), thereby enabling prompt and aggressive sur¬ gery.…”

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confidence: 99%