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[A woman with hemorrhagic shock]
Liv Mundal1, Dejan Ignjatovic, Villy Våge
1Medisinsk avdeling, Førde sentralsjukehus, 6807 Førde. livmun@hotmail.com
Summary
A rare aorto-duodenal fistula caused fatal gastrointestinal bleeding in an elderly patient. Early recognition of this complication after aortic surgery is crucial for prompt referral and management.
Area of Science:
- Vascular Surgery
- Gastroenterology
Background:
- Acute upper gastrointestinal bleeding is a critical medical emergency requiring swift diagnosis and intervention.
- Aorto-enteric fistulas, particularly secondary types, are serious complications following aortic reconstructive surgery.
Observation:
- An 82-year-old female presented with hematemesis and rapidly progressed to hemorrhagic shock.
- Emergency laparotomy revealed massive duodenal bleeding, and the patient subsequently experienced cardiovascular collapse and expired.
- The patient had a history of duodenal ulcer and an abdominal aortic aneurysm at the site of a prior aorto-bifemoral bypass.
Findings:
- Autopsy confirmed an aorto-duodenal fistula, a direct communication between the aorta and the duodenum.
- Secondary aorto-enteric fistulas are known complications of abdominal aortic reconstructive procedures.
- The estimated incidence in Norway is 1.6%, with approximately three cases expected annually.
Implications:
- Patients presenting with severe gastrointestinal bleeding and a history of aortic reconstruction should be identified as a high-risk group.
- Prompt referral to specialized vascular surgery centers is essential for optimal management of suspected aorto-enteric fistulas.
- Timely diagnosis and intervention can improve outcomes for this life-threatening condition.