원발성 대동맥-십이지장루 1예

Abstract

Aortoenteric fistula is a rare and life-threatening cause of upper gastrointestinal hemorrhage. Fistulas may be classified as primary or secondary. Secondary aortoenteric fistulas usually occur at the suture line following arterial reconstruction with prosthetic material and developed in 0.5∼2.4% of the patients. The incidence of primary fistulas was reported in 0.04∼0.07% in a large autopsy series and is 0.69∼2.36% in patients with abdominal aortic aneurysm. Atherosclerosis is now the dominant cause. The mortality rate of patients with primary aortoduodenal fistula (ADF) is extremely high, principally because the diagnosis is difficult and seldomly established before the massive bleeding results in emergency operation or death. This occurs predominantly in the third and fourth parts of the duodenum. Symptoms of ADF consist of flank pain or abdominal pain, hematemesis, melena, and an abdominal mass. ADF is curable, if diagnosed and treated with surgical intervention before the onset of lethal massive hemorrhage. We report a case of primary ADF with a review of the literatures.