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CASE REPORT
Secondary aortoduodenal fistula and the unrecognised herald bleed
  1. Francesc Simó Alari1,
  2. Esther Molina González2,
  3. Israel Gutierrez1,
  4. Aïcha Ahamdanech-Idrissi3
  1. 1General surgery, Centre Hospitalier de la val d’Ariege, Foix, France
  2. 2Intensive Care Medicine, Centre hospitalier du val d’Ariege, Foix, France
  3. 3Anesthesiology, Centre hospitalier du val d’Ariege, Foix, Midi Pyrénées, France
  1. Correspondence to Dr Francesc Simó Alari, f.simo.alari{at}gmail.com

Summary

A 65-year-old man with history of aortobifemoral surgery 4 years ago was admitted to hospital after sudden abdominal pain. Initially misdiagnosed as renal colic, he was treated with analgesics, and while on observation he started with haematemesis, rapidly responding to volume infusion. Upper gastrointestinal endoscopy showed fresh blood in the stomach with no visible active bleeding. CT scan showed an important contrast extravasation from the aorta to the third duodenal portion, restarting haemodynamic instability and a cardiac arrest. Cardiopulmonary resuscitation (CPR) manoeuvres followed by intense fluid resuscitation and urgent laparotomy with a fast transabdominal supracoeliac aortic clamping was performed. After multiple blood and plasma unit transfusion and intravenous norepinephrine, two more cardiac arrests were recovered. Unfortunately, after aggressive management, the patient rapidly deteriorated and deceased on the table. Aortoduodenal fistula is a rare entity causing life-threatening bleeding. Its diagnosis requires high clinical suspicion and surgery offers the only hope for survival.

  • emergency medicine
  • gi bleeding
  • vascular surgery
  • gastrointestinal surgery
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Footnotes

  • Contributors FSA: dealt directly with case, writing the report, design and data collection. EMG, IG and AA-I: dealt directly with case.

  • Funding The authors declare no contributorship nor external funding sources for the development of this document.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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