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首页> 外文期刊>BMC Cardiovascular Disorders >Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report
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Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report

机译：原发性十二指肠瘘伴腹主动脉瘤伴消化道出血：一例

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Primary aortoduodenal fistula (ADF) is a rare cause of gastrointestinal (GI) bleeding and is difficult to diagnose as the clinical presentation is subtle. Clinicians should keep a high level of suspicion for an unknown etiology of GI bleeding, especially in older patients with or without abdominal aortic aneurysm (AAA). Computed tomographic angiography (CTA) can be used to detect primary ADF. Open surgery or endovascular aortic repair (EVAR) for ADF with bleeding will improve the survival rate. We report a rare case of AAA complicating ADF with massive GI bleeding in a 73-year-old Taiwanese man. He presented with abdominal pain and tarry stool for 5?days and an initial upper GI endoscopy at a rural hospital showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9?g/dl from 12?g/dl occurred the next day. He was referred to our hospital for EVAR and primary closure of fistula defect due to massive GI bleeding with shock from ADF caused by AAA. Diagnosis was made by CTA of aorta. A timely and accurate diagnosis of primary ADF may be challenging due to insidious episodes of GI bleeding, which are frequently under-diagnosed until the occurrence of massive hemorrhage. Clinical physicians should keep a high index of awareness for primary ADF, especially in elderly patients with unknown etiology of upper GI bleeding with or without a known AAA.
机译：原发性主动脉十二指肠瘘（ADF）是胃肠道（GI）出血的罕见原因，并且由于临床表现微妙而难以诊断。临床医师应高度怀疑胃肠道出血的病因，尤其是在有或没有腹主动脉瘤（AAA）的老年患者中。计算机断层血管造影（CTA）可用于检测原发性ADF。对于有出血的ADF进行开放手术或血管内主动脉修复（EVAR）将提高生存率。我们报道了一个73岁的台湾男子罕见的AAA导致ADF伴有大量胃肠道出血的情况。他出现腹痛和柏油样便5天，在一家乡村医院进行的最初的上消化道内窥镜检查仅显示胃溃疡，但发生低血压并伴有心动过速和血红蛋白从12微克/升降至9微克/分升。明天。由于巨大的胃肠道出血以及由AAA引起的ADF引起的休克，他被转诊至我院进行EVAR和瘘管缺损的初步闭合治疗。通过主动脉CTA进行诊断。由于胃肠道出血的隐匿性发作，及时，准确地诊断原发性ADF可能具有挑战性，而在发生大量出血之前，常常会对其进行漏诊。临床医生应保持对原发性ADF的高度了解，尤其是对于上消化道出血病因不明的老年患者，不论是否患有已知的AAA。

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