Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Surgical Treatment for a Primary Arterioenteric Fistula between a Common Iliac Artery Aneurysm and the Terminal Ileum with Massive Bleeding

대량출혈을 동반한 총장골동맥류와 회장 사이에 생긴 일차성 동맥-장관루의 치험

  • Lee, Hyung-Chae (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Jun, Hee-Jae (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Choi, Kwang-Ho (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Yang-Haeng (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Hwang, Youn-Ho (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Seong-Kwang (Department of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University)
  • 이형채 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 전희재 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 최광호 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 이양행 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 황윤호 (인제대학교 의과대학 부산백병원 흉부외과학교실) ;
  • 이성광 (인제대학교 의과대학 부산백병원 흉부외과학교실)
  • Published : 2009.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

A 72-year-old man with progressive, unexplained lower gastrointestinal bleeding presented to the emergency department with abdominal pain and shock. Computed tomography of the abdomen showed a fistula between a right common iliac artery aneurysm and the small intestine. Laparotomy demonstrated a saccular aneurysm of the common iliac artery with a fistulous communication to the terminal ileum. Aneurysmectomy, aortoiliac graft replacement and segmental ileocecal resection with end-to-side anastomosis were all successfully performed. For a patient having an arterioenteric fistula along with lower gastrointestinal bleeding, making an early diagnosis using computed tomography and then performing immediate surgery can be expected to save the patient's life.

진행되는 하부 위장관 출혈이 있는 72세 남자가 복통과 저혈압 상태로 응급실을 찾았다. 컴퓨터 단층 촬영상 총장골동맥류와 소장 사이의 누공을 보였다. 개복술로 총장골동맥류와 회장 말단부 사이에 누공을 확인하였다. 동맥류 절제술 후 복부대동맥과 정상적인 장골 동맥 사이에 인조혈관을 연결하였다. 회장루는 회맹장 절제술을 시행하고 회장-상행결장간 단측 문합을 시행하였다. 위장관 출혈을 동반한 동맥-장관루 환자에서 복부 컴퓨터 단층촬영 상을 이용한 빠른 진단과 즉각적인 수술이 생존 기회를 높일 것으로 생각된다.

Keywords

References

  1. Salmon M. Aneurysms de l'aorte ventral; most par rupture de la pouche arterielle dans le duodenum. Bull Soc Anal 1843;2188:18
  2. Nathan MJ, Darling RC. Massive gastrointestinal hemorrhage due to iliac artery-intestinal fistula. Ann Surg 1967; 165:448 https://doi.org/10.1097/00000658-196703000-00018
  3. Bergqvist D. Arterioenteric fistula. Review of a vascular emergency. Acta Chir Scand 1987;153:81-6
  4. Kim DY, Chung SY, Kim SK. Aortoenteric fistula - report of two cases-. J Korean Soc Vsc Surg 1994;10:106-11
  5. Saers SJ, Scheltinga MR. Primary aortoenteric fistula. Br J Surg 2005;92:143-52 https://doi.org/10.1002/bjs.4928
  6. Korkut AK, Arpinar E, Yasar T, Guncy D. Primary aortoduodenal fistula complicated by abdominal aortic aneurysm. J Cardiovasc Surg 2000;41:113-5
  7. Mark AS, Moss AA, Mccarthy S, McComin M. CT of aortoenteric fistula. Invest Radiology 1985;20:272-5 https://doi.org/10.1097/00004424-198505000-00008
  8. Jacobs MJ, Reul GJ, Gregoric I, Cooley DA. In-situ replacement and extra-anatomic bypass for the treatment of infected abdominal aortic grafts. Eur J Vasc Surg 1991;5:83-6 https://doi.org/10.1016/S0950-821X(05)80932-6
  9. Walker WE, Cooley DA, Duncan JM, Hallman GL, Ott DA, Reul GJ. The management of aortoduodenal fistula by in situ replacement of infected abdominal aortic graft. Ann Surg 1987;205:727-32 https://doi.org/10.1097/00000658-198706000-00015
  10. Sweeney MS, Gadaca TR. Primary aortoduodenal fistula: manifestation, diagnosis and treatment. Surgery 1984;96: 492-7
  11. Bueks JA Jr, Faries PL, Gravereaux EC, Hollier LH, Marin ML. Endovascular repair of bleeding aortoenteric fistulas: a 5-year experience. J Vasc Surg 2001;34:1055-9 https://doi.org/10.1067/mva.2001.119752