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Technical Aspects of the Mouse Aortocaval Fistula
Published on: July 11, 2013
Aortoenteric fistula in a 25-year-old man
Amy C Ramsay1, Michael P Ramsay, Pauline E Meekins
1Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
The Journal of Emergency Medicine
|June 20, 2013
Summary
Aortoenteric fistula (AEF) can occur after abdominal trauma, not just in older patients with aneurysms. Early recognition of this rare but fatal condition, even with subtle symptoms, is critical for emergency physicians.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Emergency Medicine
Background:
- Aortoenteric fistula (AEF) is a rare complication typically associated with abdominal aortic aneurysms in older individuals.
- Traumatic injuries and subsequent surgical repair can also precipitate AEF formation, expanding the at-risk patient population.
Observation:
- A 25-year-old male presented with an aortoduodenal fistula weeks after an abdominal stab wound.
- The patient experienced a "herald bleed," a self-limited hemorrhage preceding potentially fatal exsanguination.
- Classic diagnostic signs (pain, pulsatile mass, bleeding) were absent, complicating early diagnosis.
Findings:
- AEF can manifest as upper or lower gastrointestinal bleeding due to its variable location.
- Diagnostic imaging may be misleading and delay essential surgical intervention.
- High mortality rates underscore the urgency of prompt diagnosis and treatment.
Implications:
- Emergency physicians must consider AEF in younger patients with a history of abdominal trauma, even without typical presenting signs.
- Clinical suspicion based on history and physical examination is paramount for timely diagnosis.
- Rapid identification and surgical repair are crucial, as untreated AEF is universally fatal.
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