Delgadillo TGH, Velásquez GJA, Fenig RJ, Campos CF, Cervantes CJ, Medina PB

Language: Spanish
References: 13
Page: 234-237
PDF size: 65.28 Kb.

ABSTRACT

Objective: To describe the case of a patient with massive hemorrhage of the proximal digestive tract, secondary to a gastric ulcer with findings of an aortogastric fistula.
Setting: Third level health care hospital.
Description of the case: Woman of 76 years of age with symptomatology of 5 days of evolution, three melenic stools per day and hematemesis in two occasions. Emergency endoscopy revealed a hiatal hernia due tonon-reducible sliding. At the level of the greater curvature, in the gastric fundus, a rounded ulcer with well defined borders and active arterial hemorrhage was observed, sclerotherapy was performed, inducing increase in bleeding and leading to hypovolemic shock. The patient was subjected to emergency surgery, revealing a hemorrhagic ulcer of the arterial vessel at the gastric fundus level over the greater curvature with a fistulous tract to the aorta. Total gastrectomy was performed, at the end of the procedure a lesion in the supraceliac abdominal aorta was observed, the inflammatory margins of the aorta wall were resected, placing a dacron patch; only damage control surgery was performed due to the unstable conditions of the patient with a hemorrhage of approximately 6000 L. She was operated again on the next day performing a Rouxin-Y lateral-terminal esophagus-jejunal anastomosis.
Conclusion: Aortoenteric fistulas are uncommon in our milieu: there were 250 cases reported in the world literature at the end of the last decade. Treatment is surgical once diagnosis has been reached. In cases of emergency surgery, mortality is high due to the massive hemorrhage. Prompt and timely intervention is of utter importance.

REFERENCES

1. Wheeler WE, Hanks J, Raman VK. Primary aortoenteric fistulas. Am Surg 1992; 58: 53-4.

2. Brown PW, Sailors DM, Headrick JR, Burns RP. Primary aortojejunal fistula: a case report. Am Surg 1999; 65: 139-41.

3. Nagy SW, Marshall JB. Aortoenteric fistulas. Recognizing a potentially catastrophic cause of gastrointestinal bleeding. Postgrad Med 1993; 93: 211-2, 215-6, 219-22.

4. Antinori CH, Andrew CT, Santaspirt JS, Villanueva DT, Kuchler JA, de León ML, et al. The many faces of aortoenteric fistulas. Am Surg 1996; 62: 344-9.

5. Voorhoeve R, Moll FL, de Letter JA, Bast TJ, Wester JP, Slee PH. Primary aortoenteric fistula: report of eight new cases and review of the literature. Ann Vasc Surg 1996; 10: 40-8.

6. Bashir RM, al-Kawas FH. Rare causes of occult small intestinal bleeding, including aortoenteric fistulas, small bowel tumors, and small bowel ulcers. Gastrointest Endosc Clin North Am 1996; 6: 709-38.

7. Schwab CW, McMahon DJ, Phillips G, Pentecost MJ. Aortic balloon control of a traumatic aortoenteric fistula after damage control laparotomy: a case report. J Trauma 1996; 40: 1021-3.

8. Grande JP, Ackermann DM, Edwards WD. Aortoenteric fistulas. A study of 28 autopsied cases spanning 25 years. Arch Pathol Lab Med 1989; 113: 1271-5.

9. Sigler ML, Gutiérrez CR, Ibarrola JL. Complicaciones gastrointestinales de la cirugía aortoiliaca. Rev Méx Angiol 1983; 121: 8.

10. Sigler Morales L, Sigler Morales A. Hemorragia aguda del tubo digestivo alto. En: Gutiérrez SC, Arrubarrena AVM. Fisiopatología quirúrgica del aparato digestivo. 2ª edición; México, D.F. Ed. El Manual Moderno: 1996: 197-207.

11. Low RN, Wall SD, Jeffrey RB Jr, Sollitto RA, Reilly LM, Tierney LM Jr. Aortoenteric fistula and perigraft infection: evaluation with CT. Radiology 1990; 174: 157-62.

12. Moulton S, Adams M, Johansen K. Aortoenteric fistula. A 7 year urban experience. Am J Surg 1986; 151: 607-11.

13. Peck JJ, Eidemiller LR. Aortoenteric fistulas. Arch Surg 1992; 127: 1191-3.