Lower Tract Bleeding Research Articles

Aortoenteric Fistula in A 25-Year-Old Man

BackgroundAortoenteric fistula (AEF) is a rare diagnosis that is often considered only in older patients with histories of abdominal aortic aneurysm. ObjectivesTo remind emergency physicians that traumatic injury and repair put patients at risk for formation of AEF. Case ReportWe discuss the case of a 25-year-old man who developed an aortoduodenal fistula weeks after a stab wound to the abdomen. AEF can occur anywhere along the gastrointestinal tract and can therefore present as either upper or lower tract bleeding. The expected triad of pain, pulsatile mass, and gastrointestinal bleeding is unfortunately rarely present, making diagnosis difficult. Patients often present with a self-limited herald bleed that precedes the fatal exsanguination by hours to days. Diagnosing the fistula at the time of the herald bleed can be difficult but lifesaving. Imaging studies are often misleading and only delay definitive operative treatment. Even with prompt diagnosis and treatment, mortality is high; without repair, it is 100%. ConclusionThis case highlights the importance of suspecting and quickly recognizing AEF based on history and physical examination alone. After extensive preoperative imaging to confirm the diagnosis, this patient nearly died in the operating room as surgeons took down adhesions trying to reach the fistula to repair it.

Current Management of Acute Gastrointestinal Hemorrhage

This is a brief, rather superficial review of upper gastrointestinal bleeding, with some mention of lower tract bleeding. The coverage is spotty. Pathology is presented as a series of photographs of gross specimens. The chapter on barium studies, likewise, is composed of a large group of films illustrating lesions of the tract, including those with a bleeding potential and those without. The chapter on ulcer disease is concerned mainly with the pathophysiology of the crater. The reader will have trouble with some of the teachings, such as the statements that when there is esophagitis there invariably is a hiatus hernia, and that ulcers develop from erosions. (Forgive us, Konjetzny!) Wilson's chapter on arteriography is excellent, well worth review by all gastroenterologists and general surgeons. It is full of excellent detail and good sense.