PubMed · 10840310
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D Külling. 2000. Aortoenteric fistula.. https://doi.org/10.1067/mge.2000.103672
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HISTORY AND CLINICAL FINDINGS: A 60-year-old man had a dacron aortofemoral bypass graft inserted to replace a ruptured infrarenal aortic aneurysm rupture. He subsequently had tachyarrhythmic atrial fibrillation with heart failure, NYHA class IV, and diffuse abdominal pain associated with watery diarrhea. INVESTIGATIONS: Stool tests merely demonstrated Candida albicans. Abdominal ultrasound revealed intestinal loops with thickened walls and decreased peristalsis. Coloscopy demonstrated a retroperitoneal intestinal perforation with abscess formation resulting from ulcerative necrotizing rectosigmoid colitis which had also uncovered the vascular prosthesis near the abscess cavity. DIAGNOSIS: Ischemic transmural necrotizing rectosigmoiditis with retroperitoneal intestinal perforation. TREATMENT AND COURSE: The rectosigmoid colon was resected and an end-colostomy made with closure of the rectal stump (Hartmann's operation). The uncovered right limb of the vascular graft was covered completely and was discharged, being now mobile using a walking frame. There was no evidence of infection in the dacron prosthesis. CONCLUSION: A transmural progression of an ischemic colitis should be considered as a late sequela after emergency vascular reconstruction of the abdominal aorta. Even if symptoms are mild, early postoperative sigmoidoscopy is indicated.
Splenic artery aneurysms (SAA) occur predominantly in women and a majority of the aneurysms are asymptomatic until rupture. Over half of those that rupture occur during pregnancy or in women who have had children. Rupture during pregnancy is associated with a very high maternal and fetal mortality rate. Although this condition is uncommon, good materno-fetal outcome can only be achieved by early diagnosis and prompt treatment. It is therefore important to increase awareness of this condition so that obstetricians and other frontline staff can entertain the diagnosis of a ruptured splenic artery aneurysm in any pregnant woman who presents with severe upper abdominal pain. This article reviews the aetiology, clinical features, diagnosis and treatment of this potentially lethal condition.
Aneurysm rest occurs in 1 to 10% of operated patients and of these, 21.8% are due to slipped clips. D'Angelo and coworker (1998) found 1 to 10% of residual aneurysms. They suggest that if the residual aneurysm has less than 2 mm, angiographic control must be performed after 3-5 years of the surgical procedure; if between 2 and 4 mm, the angiographic control must be done in the first 6 months after surgery and then, anually. If it has more than 4mm a direct surgical approach is advised. We present the cases of two female patients submitted to microsurgical treatment of intracranial aneurysm, without any intra-operative abnormal event. The angiographic study further made showed displacement of the clip from its original position and aneurysm again. A review of the literature is also presented.