Cases reported "Duodenal Diseases"

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1/5. 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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2/5. Massive gastrointestinal bleeding due to cholecystoduodenal fistula. Case report.

    A young man presenting with massive haematemesis and melaena was found to have a cholecystoduodenal fistula secondary to duodenal ulcer. Surgical treatment was successful.
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ranking = 1
keywords = haematemesis
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3/5. hamartoma of Brunner's glands causing massive haematemesis.

    BACKGROUND: Brunner's gland hamartomas are very uncommon lesions and are usually asymptomatic. methods: A 77-year-old man was urgently operated on for massive upper gastrointestinal bleeding, associated with haematemesis. RESULTS: A 3.5 x 3 x 3 cm mass arising from the anterior aspect of the first part of the duodenum was found. Histologic examination showed groups of Brunner-type glands without atypia; these coexisted with heterotopic pancreatic acini and ducts. CONCLUSIONS: This is a very rare cause of massive upper gastrointestinal bleeding and may easily be confused with bleeding from a peptic ulcer.
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ranking = 5
keywords = haematemesis
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4/5. 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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5/5. 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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