RESUMEN
Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
Asunto(s)
Aneurisma de la Aorta Abdominal , Enfermedades de la Aorta , Rotura de la Aorta , Enfermedades Duodenales , Fístula Intestinal , Fístula Vascular , Aorta Abdominal , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Duodeno , Hemorragia Gastrointestinal/etiología , Humanos , Fístula Intestinal/complicaciones , Fístula Intestinal/diagnóstico por imagen , Masculino , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
Asunto(s)
Humanos , Masculino , Enfermedades de la Aorta , Rotura de la Aorta , Fístula Vascular/cirugía , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico por imagen , Fístula Intestinal/complicaciones , Fístula Intestinal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico por imagen , Aorta Abdominal , Duodeno , Hemorragia Gastrointestinal/etiologíaRESUMEN
BACKGROUND: Coronary artery fistulae (CAF) are rare anomalies. Left anterior descending(LAD) to Pulmonary artery (PA) CAF, represent a minority of cases. Large fistulas, create a significant shunt and a "steal phenomenon", and can lead to myocardial ischemia and heart failure (HF) if left untreated. CASE PRESENTATION: We present a 57 years old female with a large LAD to PA fistulae. Given the rare occurrence and the predominance of low shunt of LAD to PA CAF, this case is functionally exceptional in this fistulae variant, causing a significant shunt which resulted in daily cardiac ischemic chest pain. Diagnosis work up included a nuclear stress test, Coronary Angiography and 3-D Coronary Computed Tomography Angiogram (CCTA). Traditionally, surgery has been the main therapy for symptomatic CAF, but transcatheter closure has emerged as a less invasive strategy and is a valuable alternative or even preferable if no associated cardiac conditions are present, provided the anatomical characteristics of the fistulae are appropriate. The surgical approach includes off pump epicardial interruption of the fistula or closure through a cardiac chamber (trans-cameral) or transpulmonary, or epicardial closure using Cardiopulmonary bypass. Caution must be taken in cases of CAF with Coronary Artery (CA) aneurysm in dominant CA, or drainage into the Coronary Sinus, as the possibility of ischemic complications are higher. Due to anatomical considerations and tortuosity of the fistulae, our patient was considered not amenable for percutaneous closure and surgery was opted. Epicardial closure of the fistula was performed on a beating heart, off pump. Outcome was favorable with complete resolution of ischemic symptoms. CONCLUSION: Symptomatic, high shunt CAF must be interrupted. The presence of daily ischemic symptoms in our case report patient, is worth to be remarked. Alternatives for fistulae closure are transcatheter or surgery, depending on anatomic variables and the presence of associated cardiac conditions. Surgical epicardial closure of LAD to PA fistulae variant can be done with very low mortality and morbidity, but other variants with coronary aneurysm, drainage in the coronary sinus or other concomitant cardiac defects, may result in ischemic complications and higher perioperative mortality and worse long- term outcome.
Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Anomalías de los Vasos Coronarios/cirugía , Arteria Pulmonar/cirugía , Fístula Vascular/complicaciones , Angiografía Coronaria , Seno Coronario , Vasos Coronarios , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Persona de Mediana Edad , Isquemia Miocárdica/cirugía , Resultado del TratamientoAsunto(s)
Enfermedades de la Aorta/complicaciones , Fístula Esofágica/complicaciones , Hemorragia Gastrointestinal/etiología , Fístula Vascular/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Aortografía , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Endoscopía Gastrointestinal , Procedimientos Endovasculares/instrumentación , Fístula Esofágica/diagnóstico por imagen , Fístula Esofágica/cirugía , Resultado Fatal , Hemorragia Gastrointestinal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
INTRODUCCIÓN: Las fístulas aortobronquiales son una causa muy infrecuente de hemoptisis masiva. Se asocia a la presencia de un aneurisma aórtico, y su evolución es siempre letal sin un tratamiento oportuno. El objetivo es presentar un caso de fístula aortobronquial y la revisión de bibliografía respectiva. Presentación del caso: Paciente de género femenino, de 76 años, hipertensa y diabética, sin otros antecedentes mórbidos. Ingresó al Servicio de Urgencia por hemoptisis posterior a caída a nivel. La radiografía de tórax mostró imagen hiperdensa en vértice pulmonar izquierdo, asociada a desviación mediastínica contralateral. Evolucionó con episodio de hemoptisis masiva el cual fue tratado satisfactoriamente con reposición de volumen y transfusión de hemoderivados. La tomografía computada de tórax con contraste mostró aneurisma de aorta torácica, de diámetro máximo de 10,8 cm...
INTRODUCTION: Aortobronchial fistula is a very rare cause of massive hemoptysis. It is associated with the presence of an aortic aneurysm and its evolution is always fatal without prompt treatment. The objective is to present a case of aortobronchial fistula and to review the respective literature. Case Report: A 76 years old woman, hypertensive and diabetic, no other known morbid history. She was admitted to emergency room with mild hemoptysis after a fall. Chest X-ray showed hyperdense image in the left lung apex, associated with contralateral mediastinal shift. She was treated with antibiotics and antitussives. She evolved with an episode of massive hemoptysis which was successfully treated with fluid resuscitation and blood transfusion. Chest computed tomography showed large thoracic aortic aneurysm with a maximum diameter of 10.8 cm
Asunto(s)
Humanos , Aneurisma de la Aorta , Aneurisma de la Aorta/complicaciones , Fístula Vascular , Fístula Vascular/complicaciones , Hemoptisis/etiología , Tomografía Computarizada por Rayos X , Fístula Bronquial , Fístula Bronquial/complicaciones , Resultado FatalRESUMEN
Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.
Asunto(s)
Hemorragia Gastrointestinal/etiología , Arteria Ilíaca , Fístula Intestinal/complicaciones , Enfermedades del Sigmoide/complicaciones , Neoplasias Testiculares/complicaciones , Fístula Vascular/complicaciones , Adulto , Hemorragia Gastrointestinal/cirugía , Humanos , Arteria Ilíaca/cirugía , Masculino , Enfermedades del Sigmoide/cirugía , Resultado del TratamientoRESUMEN
Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.
Asunto(s)
Adulto , Humanos , Masculino , Hemorragia Gastrointestinal/etiología , Arteria Ilíaca , Fístula Intestinal/complicaciones , Enfermedades del Sigmoide/complicaciones , Neoplasias Testiculares/complicaciones , Fístula Vascular/complicaciones , Hemorragia Gastrointestinal/cirugía , Arteria Ilíaca/cirugía , Enfermedades del Sigmoide/cirugía , Resultado del TratamientoRESUMEN
It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.
Asunto(s)
Aneurisma de la Aorta Torácica/inducido químicamente , Rotura de la Aorta/inducido químicamente , Lupus Eritematoso Sistémico/tratamiento farmacológico , Esteroides/efectos adversos , Adulto , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Fístula Esofágica/complicaciones , Resultado Fatal , Femenino , Hemorragia/etiología , Humanos , Stents , Fístula Vascular/complicacionesRESUMEN
It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.
Paciente de 25 anos, do sexo feminino, portadora de lúpus eritematoso sistêmico, fazendo uso de corticoesteroide havia 19 anos, deu entrada em unidade de emergência com aneurisma roto de aorta torácica descendente. Foi submetida a tratamento endovascular com 2 stents, recebeu alta hospitalar no 13º dia de pós-operatório, em boas condições de saúde. Três meses depois, retornou em choque hemorrágico secundário a hemorragia digestiva alta. Feito o diagnóstico de fístula aorto-esofágica, foi submetida à cirurgia aberta de emergência, indo a óbito durante o período pós-operatório.
Asunto(s)
Adulto , Femenino , Humanos , Aneurisma de la Aorta Torácica/inducido químicamente , Rotura de la Aorta/inducido químicamente , Lupus Eritematoso Sistémico/tratamiento farmacológico , Esteroides/efectos adversos , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Fístula Esofágica/complicaciones , Resultado Fatal , Hemorragia/etiología , Stents , Fístula Vascular/complicacionesRESUMEN
A transhepatic central venous catheter was implanted in a 2-year-old child with a history of multiple venous access procedures and superior and inferior vena cava thrombosis. After 2 weeks, inadvertent dislodgement of the catheter was complicated by a biloma. The biloma was percutaneously drained, but a biliary-venous fistula led to a rapidly progressive and fatal bilhemia. We report this case as an infrequent complication of transhepatic catheterization.
Asunto(s)
Fístula Biliar/sangre , Cateterismo Venoso Central/efectos adversos , Hígado , Fístula Vascular/sangre , Vena Cava Inferior , Antibacterianos/administración & dosificación , Bilis , Conductos Biliares/diagnóstico por imagen , Fístula Biliar/complicaciones , Bilirrubina/sangre , Catéteres de Permanencia/efectos adversos , Preescolar , Drenaje , Epilepsia/complicaciones , Falla de Equipo , Resultado Fatal , Femenino , Fiebre/etiología , Venas Hepáticas , Humanos , Hiperbilirrubinemia/etiología , Ictericia/etiología , Leucocitosis/etiología , Hígado/diagnóstico por imagen , Flebografía , Ultrasonografía , Fístula Vascular/complicaciones , Trombosis de la Vena/complicacionesRESUMEN
The purpose of this presentation is to report three adult patients with aortoenteric fistula whose initial presentation was abdominal pain and digestive bleeding. We stress the low incidence of this disease as a cause of digestive bleeding, its high mortality and the need of high clinical suspicion for its diagnosis. We discuss the different sites of the aortoenteric fistulas, probable physiopathological mechanisms that generate them and their elevated association with the presence of vascular prostheses.
Asunto(s)
Enfermedades de la Aorta/complicaciones , Hemorragia Gastrointestinal/etiología , Fístula Intestinal/complicaciones , Fístula Vascular/complicaciones , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Resultado Fatal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirugía , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Laparotomía/efectos adversos , Masculino , Persona de Mediana Edad , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosAsunto(s)
Embolización Terapéutica , Fístula/terapia , Enfermedades del Pene/terapia , Perineo/irrigación sanguínea , Fístula Vascular/terapia , Adulto , Fístula/complicaciones , Fístula/diagnóstico , Hematuria/etiología , Humanos , Masculino , Enfermedades del Pene/complicaciones , Enfermedades del Pene/diagnóstico , Fístula Vascular/complicaciones , Fístula Vascular/diagnósticoRESUMEN
Coronary artery fistula is a rare condition in which a communication exists between a coronary artery an a cardiac chamber or systemic vein. It causes an obligatory shunt from the high-pressure coronary artery to a lower-pressure cardiac chamber. We report a case of right coronary artery fistula draining into the right ventricle, echocardiographic features and interventional catheterization.
Asunto(s)
Cardiomiopatías/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Ventrículos Cardíacos , Fístula Vascular/complicaciones , Cateterismo Cardíaco , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/terapia , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Lactante , Masculino , Ultrasonografía , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/terapiaRESUMEN
We report a case in which a neonate with transposition of the great arteries and intact ventricular septum with unrestricted atrial communication had persistent hypoxemia probably due to a congenital left ventricle to coronary sinus fistula.
Asunto(s)
Transposición de los Grandes Vasos/complicaciones , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico , Arterias , Ecocardiografía Doppler en Color , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Recién NacidoRESUMEN
Biliovascular fistulas are abnormal communications with two types of clinical manifestations depending on type of flow in fistulous tract: 1) hemorrhage into biliary tract known as hemobilia, or 2) bile into bloodstream, known as bilhemia. Historically, this complication has been treated with surgery; however, technological progress at present allows treatment with intervention techniques without surgery being mandatory. In 1975, Clemens and Wittrin introduced the term bilhemia, a rare complication of hepatic damage producing excessively high levels of serum bilirubin and moderate rise of hepatic enzymes secondary to post-traumatic intrahepatic biliovenous fistula. Although this pathology is rare, it is considered dangerous; of 50 patients reported in the literature, 25 died due to this problem. The main purpose of treatment is to release tract obstruction by endoscopic sphincterotomy of Vater's papilla or, if the process is localized in proximal areas of biliary tract, through percutaneous biliary drainage or preferably nasobiliary drainage with continuous suction. This procedure can at least produce temporary relief and occasionally fistula closure. A longer effect can be achieved with biliary stent placement. We describe what is, to our knowledge, the first case of diagnosis and successful treatment of non-traumatic bilhemia with endoscopic sphincterotomy and nasobiliary catheter placement.
Asunto(s)
Bilis , Fístula Biliar/sangre , Fístula Biliar/complicaciones , Fístula Vascular/sangre , Fístula Vascular/complicaciones , Anciano , Cateterismo , Femenino , Humanos , Esfinterotomía EndoscópicaRESUMEN
This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention.
Asunto(s)
Enfermedades de la Aorta/complicaciones , Fístula Bronquial/complicaciones , Hemoptisis/etiología , Fístula Vascular/complicaciones , Aorta Torácica , Enfermedades de la Aorta/cirugía , Fístula Bronquial/cirugía , Resultado Fatal , Hemoptisis/cirugía , Humanos , Masculino , Persona de Mediana Edad , Fístula Vascular/cirugíaRESUMEN
This is a report of a 61 year old man who was admitted at the Intensive Care Unit because of massive hemoptysis and respiratory failure. Four years before he had had an aortic dissection type A, and at that time an aortic valve, ascending aorta and aortic arch replacement, had been carried out. A thorax CT scan showed an aneurysm of the ascending aorta. A bronchoscopy was normal. In the angiography, a collateral of the left mammary artery was identified as the cause of bleeding and was subsequently embolized. After the procedure, the patient had a new episode of massive hemoptysis, and surgery was recommended. During surgery, the diagnosis of aortobronchial fistula was confirmed but the patient died during the intervention. (Au)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hemoptisis/etiología , Fístula Bronquial/complicaciones , Fístula Vascular/complicaciones , Enfermedades de la Aorta/complicaciones , Hemoptisis/diagnóstico , Hemoptisis/cirugía , Fístula Bronquial/diagnóstico , Fístula Bronquial/cirugía , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Aorta Torácica , Resultado FatalRESUMEN
Congenital portosystemic venous shunt (PSVS), considered to be a rare disease, can lead to hepatic encephalopathy (HE). With improvements in diagnostic imaging techniques, the number of infants and children with documented PSVS has increased. The natural course of the disease and indications for surgical closure of the shunt vessel have not been well defined. We reviewed 51 cases of congenital PSVS in Japan; 34 patients had an intrahepatic PSVS, and 17 had an extrahepatic PSVS. There were 12 patients with HE at the time of diagnosis. The frequency of HE increased in subjects over 60 years of age. Children with HE had a shunt ratio exceeding 60%. When the shunt ratio was less than 30%, HE did not occur. Twenty of 28 patients under the age of 15 years had hypergalactosemia at the time of neonatal screening. Part of the congenital intrahepatic PSVS spontaneously closed. Surgical closure of a PSVS may be an approach expected to prevent HE when the shunt ratio exceeds 60%.
Asunto(s)
Encefalopatía Hepática/etiología , Vena Porta/anomalías , Fístula Vascular/congénito , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Galactosemias/complicaciones , Humanos , Lactante , Recién Nacido , Japón/epidemiología , Hígado/patología , Masculino , Persona de Mediana Edad , Fístula Vascular/complicaciones , Fístula Vascular/epidemiología , Fístula Vascular/patología , Fístula Vascular/cirugíaRESUMEN
Bleeding from an arterio-esophageal fistula is a rare and nearly lethal condition and surgical treatment is the only curative option. We report a case of bleeding from a fistula from an aberrant right subclavian artery to the esophagus. Diagnosis was made only at necropsy, despite of three previous laparotomies. This anatomical variation is found in 0.5% of the general population. Development of a communication between this artery and the esophagus, secondary to aneurysmatic dilatation or to prolonged nasogastric intubation, as probably occurred with this patient, is a extremely rare condition. Surgical treatment depends on the early recognition of clinical signs of the arterio-esophageal communication, before the onset of systemic complications of hypovolemic shock.