293 research outputs found

    Aortoduodenal Fistula Forms From Primary Aortic Stump Graft in a Two-Time Multi-Visceral Transplant Patient with Presentation of Gastrointestinal Bleed and Bowel Perforation: A Case Report

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    Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of the patient and preserving the current multi-visceral transplant. Due to the rising number of intestinal transplants and multi-visceral transplants performed, clinicians should always have high suspicion of aortoduodenal fistulas in any transplant patient that presents with acute abdominal pain and lower gastrointestinal bleeding. With quick diagnosis, survival rate of aortoduodenal fistulas in multi-visceral transplant patientsmay improve

    Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient

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    Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases

    Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft

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    We report a case of aortoduodenal fistula 5 years after uncomplicated endovascular abdominal aortic aneurysm repair. The diagnosis was confirmed by abdominal computed tomography scan and esophagogastroduodenoscopy. The patient was successfully treated with primary duodenal repair, removal of the infected graft, in situ placement of a bifurcated graft, and omental interposition. Review of the literature identifies this as one of very few documented aortoduodenal fistulas after endovascular aneurysm repair. Fistulization occurred despite accurate stent graft placement without migration, endoleak, or aortic sac size enlargement on annual postoperative imaging studies

    Fistule aorto-dudoénale après pose de prothèse vasculaire aortique : une observation clinique inhabituelle: Aortoduodenal fistula following aortic prosthesis. An uncommon case report

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    Secondary aortodigestive fistula is a rare and life-threatening long-term complication of abdominal aortic surgey. The diagnosis of gastrointestinal bleeding secondary to aortoduodenal fistula is often difficult in practice. The interval between first intervention and developpement of the fistula can vary from months to years. We report a case of a patient with aortic prosthesis who was admitted for gastrointestinal bleeding secondary to aortoduodenal fistula. Les fistules aorto-digestives constituent une complication rare mais gravissime des prothèses aortiques. L’intervalle de temps entre la mise en place de la prothèse et la survenue de cette complication, varie de quelques mois à quelques années. Le diagnostic des hémorragies digestives sur fistule aorto-duodénale est souvent difficile. Dans ce cas clinique, nous présentons un patient avec prothèse aortique hospitalisé pour hémorragie digestive

    Granulomatous hepatitis, choroiditis and aortoduodenal fistula complicating intravesical Bacillus Calmette-Guérin therapy: Case report

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    <p>Abstract</p> <p>Background</p> <p>Intravesical instillation of Bacillus Calmette-Guérin (BCG) is the treatment of choice for superficial bladder carcinoma. Complications of BCG therapy include local infections and disseminated BCG infection with multiple endorgan complications.</p> <p>Case Presentation</p> <p>We report a case of disseminated, post-treatment BCG infection that initially presented with granulomatous hepatitis and choroiditis. After successful anti-mycobacterial therapy and resolution of the hepatic and ocular abnormalities, the patient developed an acute upper gastrointestinal hemorrhage from an aortoduodenal fistula that required emergency surgery. The resection specimen revealed multifocal, non-caseating granulomas, indicating mycobacterial involvement.</p> <p>Conclusions</p> <p>This case highlights the varied end organ complications of disseminated BCG infection, and the need for vigilance even in immuno-competent patients with a history of intravesical BCG treatment.</p

    Diagnosis of Aortic Aneurysm

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    A Case of Intrathoracic Stomach and Spleen After Aortic Repair: An Unusual Complication

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    A patient is described who presented with an intrathoracic stomach and spleen two weeks after aortic repair for an aortoduodenal fistula. At an urgent laparotomy the stomach was repositioned and the spleen removed. The patient recovered fully. The possible mechanism of this severe complication is discussed and relevant literature reviewed

    Successful Treatment of Secondary Aortoenteric Fistula with a Special Graft

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    Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection
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