Document Detail

Improvements in the diagnosis and management of aortoenteric fistula.
MedLine Citation:
PMID:  3985288     Owner:  NLM     Status:  MEDLINE    
To assess the impact of an aggressive approach (early operation, graft removal, and extraanatomic bypass) adopted by us 5 years ago in patients with aortic synthetic grafts and gastrointestinal bleeding, we reviewed our 15 year experience with aortoenteric fistula in 13 patients. The courses of six patients from the recent series (1979 through 1984) were contrasted with those of seven patients from our earlier series (1968 through 1978). Twelve of 13 patients presented with gastrointestinal bleeding (usually low volume), and no patient presented in shock. Six of seven patients in Series I (earlier series) had positive blood cultures, whereas only two of six in Series II (recent series) had this finding. Of the 13 patients, 10 underwent preoperative endoscopy. It was only with consistent visualization of third and fourth portions of the duodenum that a diagnosis of aortoenteric fistula was established (three of four patients 75 percent). Although the upper gastrointestinal series was abnormal more frequently (five of seven patients, 71 percent) than arteriograms (three of nine patients, 33 percent), the latter was more specific for a predisposing lesion. At surgery, nine (70 percent) patients had an anastomotic fistula and four (30 percent), a false aneurysm. Although only one of seven patients in Series I survived (14 percent), four of six patients in Series II were alive at last follow-up in September 1984 (67 percent). Early diagnosis followed by prompt operation with removal of the synthetic graft and extraanatomic bypass is associated with an improved survival for patients with aortoenteric fistula, but the degree of preoperative sepsis as indicated by positive blood cultures appears to be an important prognostic sign.
T F O'Donnell; G Scott; A Shepard; W Mackey; R A Deterling; A D Callow
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  149     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1985 Apr 
Date Detail:
Created Date:  1985-05-15     Completed Date:  1985-05-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  481-6     Citation Subset:  AIM; IM    
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MeSH Terms
Aorta / surgery
Aortic Aneurysm / diagnosis
Aortic Diseases / diagnosis,  etiology,  surgery*
Blood Vessel Prosthesis
Diagnosis, Differential
Duodenal Diseases / diagnosis,  etiology,  surgery*
Fistula / diagnosis,  etiology,  surgery*
Intestinal Fistula / diagnosis,  etiology,  surgery*
Jejunal Diseases / diagnosis,  etiology,  surgery*
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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