Serap Baş, Elbrus Zarbaliyev, Mehmet Çağlıkülekçi, Oğuz Konukoğlu, Denyan Mansuroğl, Hakan Kilercik

Tekrarlayan sekonder aortoenterik fistüllerde cerrahi yaklaşım: Olgu sunumu

Abdominal aort anevrizmasına bağlı artan abdominal aort greft sayısı, sekonder aortoenterik fistüllerin gastrointestinal kanama nedeni olarak daha sık görülmesine neden olmuştur. Gaytada gizli kandan masif gastrointestinal kanamaya kadar değişen ve hemorajik şokun da eşlik ettiği klinik semptomları olan hastalarda yüksek düzeyde şüphe tanıda önemli bir rol oynar. Altmış beş yaşında erkek hastada ardışık olarak iki sekonder aortoenterik fistül gelişti. Bunlardan birincisi kısa sürede aort greft-jejunal ve ikincisi aort grefti-duodenal fistül idi. Hastada aortobifemoral baypas sonrası sekonder aortoenterik fistül gelişti. Hastaya greft revizyonu ve jejunal onarım yapıldı. Yeni gelişen aort grefti-duodenal fistül nedeniyle üç ay sonra tekrar ameliyat edildi. Duodenal defekt kapatıldı ve greftin tekrar enterik fistül geliştirmemesi için ekstra anatomik aortoiliyak baypas yapıldı. Hasta sorunsuz bir şekilde taburcu edildi ve ameliyatın dokuzuncu ayında herhangi bir komplikasyon izlenmedi

Surgical approach to recurrent secondary aortoenteric fistulas: A case report

The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.

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