Cases reported "Aortic Diseases"

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1/8. Fatal aortoesophageal fistula in two cases of tight vascular ring.

    Vascular rings are rare vascular congenital anomalies causing oesophageal and tracheal compression. An aortoesophageal fistula is a devastating, in part iatrogenic, complication of vascular rings. It is seen with increasing frequency, and can be misleading, since differential diagnosis with other causes of haematemesis and melaena is often difficult, especially in infants. We report two infants with aortoesophageal fistulas secondary to double aortic arches forming a vascular ring. In both, the diagnosis was missed, and massive haemorrhage led to death. In both cases, the fissuration on the oesophageal and aortic sides of the fistula had sharp edges, highly suggestive of an iatrogenic laceration caused by manipulation of nasogastric tubes. The key for the diagnosis of vascular rings is, therefore, clinical suspicion and awareness of this condition. Prompt identification in infants with stridor, wheezing, or respiratory distress can prevent prolonged intubation, thus avoiding the formation of an aortoesophageal fistula and hopefully preventing a fatal outcome.
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ranking = 1
keywords = haematemesis
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2/8. vocal cord paralysis and oesophago-broncho-aortic fistula complicating foreign body-induced oesophageal perforation.

    A 61 year old man died after presenting with a 24 h history of haematemesis and haemoptysis, and one year history of hoarseness of voice. Post-mortem examination showed a dental plate eroding through the mid-oesophagus into a bronchus and into the descending arch of the aorta, with scarring suggestive of old perforation. An organized haematoma also involved the left recurrent laryngeal nerve. Vocal cord paralysis may be a manifestation of foreign body-induced oesophageal perforation, which can lead to death from an oesophago-broncho-aortic fistula. Both complications of oesophageal perforation from a foreign body have not to our knowledge been previously reported.
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ranking = 1
keywords = haematemesis
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3/8. Fatal haematemesis in childhood associated with aorto-oesophageal fistula.

    A case of fatal haematemesis associated with a non-traumatic, non-tuberculous aorto-oesophageal fistula in a 9-year-old Nigerian boy is presented. autopsy revealed two inflamed and ulcerated mild-oesophageal pulsion diverticula, one of which had eroded into the right pleura as a sinus track. The second diverticulum had perforated and caused mediastinitis and eventually aorto-oesophageal fistula which led to the fatal haematemesis. A mild chest injury is seen as a precipitating factor of the haematemesis and not the initiator of the pathology.
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ranking = 7
keywords = haematemesis
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4/8. Aortoduodenal fistula revisited.

    Two new cases of primary aortoduodenal fistula (ADF), one associated with an arteriosclerotic aneurysm and the other without, are presented and 4 cases of primary ADF without aneurysm published between 1972 and 1985 are reviewed. The anatomic relationship of the distal part of the duodenum to the infrarenal segment of the aorta, arteriosclerosis, mechanical trauma, infection and sepsis are prominent factors in the pathogenesis of ADF irrespective of its type. Intermittent haematemesis and/or melaena are the main presenting symptoms in all variants of ADF and awareness of the existence of this condition is essential for its early detection. Upper gastrointestinal endoscopy including examination of the distal part of the duodenum and explorative laparotomy are important tools in the preoperative diagnostic workup specially in primary ADF without previous knowledge of the presence of an aneurysm.
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ranking = 1
keywords = haematemesis
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5/8. Fatal haematemesis from an aorto-oesophageal fistula of obscure aetiology: a case report.

    endoscopy, aortography and laparotomy failed to demonstrate a high aorto-oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid-thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom-free interval, and therapeutic embolization as a mode of therapy, are discussed.
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ranking = 5
keywords = haematemesis
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6/8. Case report on primary and secondary aortoenteric fistula in patient.

    A rare case is reported of a 77-year-old male with secondary aortoenteric fistula after earlier ligation of infrarenal aorta without any prosthetic grafting in the abdomen. The patient was admitted into our Clinic suffering from haematemesis and melaena. The combination of our patient's medical history, the endoscopic picture and MRI arteriography indicated the likelihood of a secondary aortoenteric fistula. Three years before this our patient had been successfully operated on for a primary aortoenteric fistula having an aneurysmectomy, ligation of the infrarenal aorta and an axillobifemoral bypass performed on him while the duodenum was sutured and patched with omentum. The choice of this surgical procedure was unavoidable because our patient had been operated on for a duodenal ulcer perforation 3 days before this. With the diagnosis of a secondary aortoenteric fistula very possible an urgent laparotomy was performed revealing a fistula between the third duodenal portion and the aortic stump. The duodenum was separated from the aortic stump to which a dacron patch, posterior peritoneum and omentum were sewn. Postoperatively the patient required respiratory support in intensive care for 4 days and was discharged within 8 days. Today, two years later, he continues to be in excellent condition.
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ranking = 1
keywords = haematemesis
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7/8. Aorto-colonic fistula as a late complication of colon interposition for oesophageal atresia.

    A 22-year-old man developed severe haematemesis 21 years after colon interposition for long-gap oesophageal atresia. A fistula, from an anastomotic ulcer to the descending thoracic aorta, was discovered and treated successfully by surgical resection. This previously unreported complication highlights the need for the prevention of peptic complications following oesophageal replacement in children.
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ranking = 1
keywords = haematemesis
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8/8. Aortoduodenal fistula.

    A primary aortoduodenal fistula is usually associated with an atherosclerotic aortic aneurysm, and a secondary fistula with a leaking anastomotic aortic suture line. Two examples of each are reported. The typical features of a primary fistula are haematemesis or melaena, pain, and a pulsatile abdominal mass; the features of a secondary fistula are haematemesis and melaena with a past history of aortic resection. The initial haemorrhage is rarely fatal: a lag period allows urgent laparotomy. The fistula is diagnosed by dissection of the fourth part of the duodenum from the aorta. The treatment is closure of the duodenum, and resection of an aneurysm if present. Reconstruction is by a graft anastomosed to the aorta proximal to the fistula, if the area is clean, or by an extra anatomical bypass, if the area is heavily contaminated.
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ranking = 2
keywords = haematemesis
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