uncommon causes of UGI bleeding - kallastro

[ArchivalUser]

A 67-year-old woman presents to the emergency department (ED) for evaluation of a small episode of hematemesis. The patient has a history of hypertension, atherosclerosis, and underwent surgery for an aortic aneurysm 2 years ago. She is hemodynamically stable on arrival. Upper endoscopy reveals a small segment of aortic graft material visible in the third portion of the duodenum without active bleeding. What is the next step in this patient™s management?

1.Aortic ultrasound
2.Endoscopic closure of the duodenal defect with metal clips
3.Observation
4.Surgical therapy
5.Tagged erythrocyte scan

[ArchivalUser]

2....

[ArchivalUser]

3333

[ArchivalUser]

Type 2, or a para-prosthetic enteric fistula, develops no communication between the bowel and the graft.

It accounts for 15% to 20% of secondary aortoenteric fistulae.

In this type of fistula, bleeding occurs from the edges of the eroded bowel by mechanical pulsations of the aortic graft.

Sepsis is more frequently associated with this type of fistula (75%).

duodenorrhaphy....is the treatment of choice here, the way it is presented in the question.... i think!

[ArchivalUser]

4. (urgent!)

Aorto-duodenal fistulas are a not so rare complication of a conventional AAA repair. Everyone can imagine what would happen in the case of a full breakthrough of the aortal flow into the duodenum.

[ArchivalUser]

....answer plz!
good q!!

[ArchivalUser]

4...........immd surgery

[ArchivalUser]

(4)
(have seen this once...)

[ArchivalUser]

Will go with 4.