Symptoms of aortointestinal fistula?

summary

Aortointestinal fistula (AEF) refers to the pathological communication between aorta and adjacent intestine. Primary AEF can be divided into two types: primary and secondary. Primary AEF has no history of aortic surgery, but is directly penetrated into the adjacent intestinal cavity due to the invasion of the aortic wall caused by the lesion of the aorta itself, which is more common in the duodenum; Secondary AEF is due to the formation of pseudoaneurysm at the anastomotic site of the graft after aortic surgery, and then rupture into the intestinal tract, so secondary AEF is also known as graft (artificial blood vessel) intestinal fistula. Secondary AEF is more common than primary AEF. What are the symptoms of aortointestinal fistula?

Symptoms of aortointestinal fistula?

The most common symptoms of primary and secondary AEF are gastrointestinal bleeding, abdominal pulsatile mass and infection, and elevated body temperature. Patients often complain of emaciation, weakness, weight loss, fever, abdominal pain or low back pain, but these are not specific symptoms. If these symptoms occur several months or years after abdominal aorta transplantation, AEF should be examined early.

Second, the vast majority of secondary AEF patients show gastrointestinal bleeding, which can be massive bleeding, but also a small amount of bleeding, manifested as fecal occult blood, most of the initial bleeding is intermittent self limiting, that is, signal bleeding. If the bleeding is serious, it can lead to myocardial ischemia, lower limb necrosis, renal failure or irreversible shock. For example, the bacterial infection of hematoma in the pseudoaneurysm formed at the graft or anastomotic site, the patient can see shivering, fever, fatigue or drainage fluid flowing out from the old incision.

Symptoms 3. Most patients with secondary AEF show gastrointestinal bleeding, which can be massive bleeding, but it can also be a small amount of bleeding, which is manifested as fecal occult blood. Most of the bleeding is initially intermittent and self limited, which is called signal bleeding. If the bleeding is serious, it can lead to myocardial ischemia, lower limb necrosis, renal failure or irreversible shock, It was reported that 66% of AEF patients had gastrointestinal bleeding, 48% had acute bleeding, and others had chronic, old or recurrent bleeding. However, 94% of AEF patients had bleeding symptoms due to hematoma bacterial infection (from surgical contamination or nearby intestinal exudation) in the pseudoaneurysm formed at the graft or anastomotic site.

matters needing attention

Postoperative management: continuous gastrointestinal decompression must be continued after operation; Maintain good blood circulation; The skin temperature, color, pulse of femoral artery, n artery and dorsalis pedis artery were observed; Broad spectrum antibiotics were used and adjusted after the results of drug sensitivity test; Pay attention to observe the nature of drainage and drainage volume; CT, MRI and ultrasound were used regularly to detect the condition of new grafted artificial vessels or artery stumps, especially the signs of pseudoaneurysm formation.