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[67-year-old patient with upper gastrointestinal bleeding]

K Welcker1, M Gross, C Zietz

  • 1Chirurgische Klinik und Poliklinik Innenstadt der LMU München (Direktor: Prof. Dr. W. Mutschler).

Deutsche Medizinische Wochenschrift (1946)
|May 28, 2003
PubMed
Summary

A rare case of upper gastrointestinal bleeding was caused by a secondary aortoduodenal fistula after nephrectomy. Exploratory laparotomy is crucial for diagnosis when other methods fail to find the bleeding source.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Urology

Background:

  • A 67-year-old patient presented with severe melaena and anemia, indicative of upper gastrointestinal bleeding.
  • The patient had a history of gastric surgery for duodenal ulcers and a prior right nephrectomy for hypernephroma.

Purpose of the Study:

  • To report a rare case of secondary aortoduodenal fistula following nephrectomy.
  • To highlight the diagnostic challenges and the importance of exploratory laparotomy in obscure gastrointestinal bleeding.

Main Methods:

  • Initial investigations included endoscopy (oesophago-duodenoscopy, colonoscopy), angiography, gastrografin passage, and ultrasound.
  • Due to persistent bleeding and failure to localize the source, an exploratory laparotomy was performed.

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Main Results:

  • Diagnostic imaging and endoscopic procedures failed to identify the source of bleeding.
  • Exploratory laparotomy revealed a bleeding fistula between the right renal artery stump and the duodenum.
  • The fistula was surgically excised and closed, resolving the bleeding.

Conclusions:

  • Secondary aortoduodenal fistula is a rare but serious complication after nephrectomy.
  • Exploratory laparotomy is a vital diagnostic and therapeutic tool when the source of obscure gastrointestinal bleeding remains unidentified.