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J Korean Soc Emerg Med > Volume 21(3); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(3): 398-401.
A Rare but Fatal Instance of Gastrointestinal Bleeding: Primary Aortoenteric Fistula
Hyun Kyung Park, Bong Hak Choi, Min Seong Kwon, Woong Jung, Sung Hyuk Park, Myung Chun Kim
1Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
2Department of Emergency Medicine, East-West Neo Medical Center, Seoul, Korea. edkmc@chol.com
ABSTRACT
Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of gastrointestinal bleeding. The diagnosis of PAEF is difficult to make. The classic triad of symptoms, i.e. gastrointestinal bleeding, abdominal pain, and a pulsating abdominal mass is overemphasized, as it occurs in less than 11~25% of the patients. For two thirds of the patients, the diagnosis is made in the operating room. Endoscopic and radiographic studies are very helpful, but the absence of abnormalities can not exclude the diagnosis. PAEF is a clinical and surgical challenge associated with high mortality. A high index of suspicion, early diagnosis and prompt and appropriate surgical intervention are essential to patient survival. Two primary aortoenteric fistulas (aortoduodenal and aortoesophageal) cases are presented and the related literature are reviewed.
Key words: Abdominal aorta, Intestinal fistula, Vascular fistula, Gastrointestinal hemorrhage, Abdominal aortic aneurysm
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