Impending aortoenteric hemorrhage: the effect of early recognition on improved outcome

Aortoenteric hemorrhage is the result of enteric erosion and necrosis of aortic wall or anastomotic site. Mechanical or bacteriologic causes may occur singly or in combination. The temporal sequence is such that warning symptoms, often including back pain, fever, hemotochezia, and anemia, are presen...

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Bibliographic Details
Published in:Annals of surgery 1980-08, Vol.192 (2), p.237-243
Main Authors: Perdue, Jr, G D, Smith, 3rd, R B, Ansley, J D, Costantino, M J
Format: Article
Language:English
Subjects:
Adult
Aged
Aorta - surgery
Aortic Aneurysm - surgery
Aortic Diseases - etiology
Aortic Diseases - surgery
Blood Vessel Prosthesis - adverse effects
Duodenal Diseases - etiology
Duodenal Diseases - surgery
Female
Fistula - etiology
Fistula - surgery
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - surgery
Humans
Intestinal Fistula - etiology
Intestinal Fistula - surgery
Male
Middle Aged
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Summary:Aortoenteric hemorrhage is the result of enteric erosion and necrosis of aortic wall or anastomotic site. Mechanical or bacteriologic causes may occur singly or in combination. The temporal sequence is such that warning symptoms, often including back pain, fever, hemotochezia, and anemia, are present long before exsanguinating hemorrhage occurs. Vigorous diagnostic efforts, including gallium-67 citrate nuclear scan and computerized axial tomography, lead to a correct diagnosis. This allows planned semielective corrective operation before severe hemorrhage begins. The ideal operation consists of extra-anatomic revascularization, excision of the infected prosthesis, bowel repair with decompression, and sump drainage. Appropriate antimicrobial therapy should be continued until healing is complete. With aggressive diagnostic and therapeutic intervention according to this plan, marked improvement in survival and limb preservation can be anticipated in patients having this complication of aortic surgery. In this series, 15 of 18 patiets having operation recovered, though delayed limb loss occurred in two.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198008000-00019