Role of endoscopy in the diagnosis of aneurysm-duodenal fistula.
BACKGROUND
Aneurysms complicated by enteric fistulae are uniformly fatal clinical conditions and therefore should be placed high on the list of possible diagnoses in any patient with aneurysmal disease and gastrointestinal bleeding. A number of different diagnostic techniques have been proposed, but most of them are usually of little help or even misleading.


METHODS
Between May 2000 and April 2002, endoscopy was performed in 290 consecutive patients with upper gastrointestinal bleeding. We retrospectively evaluated that endoscopy may provide an important diagnostic clue in aneurysm-enteric fistulae.


RESULTS
Three patients with gastrointestinal bleeding presented with aneurysmal disease complicated by duodenal fistula formation. Two patients presented with aortoduodenal fistula, and the last one hepatic artery aneurysm with duodenal fistula formation. In all of our cases, endoscopic findings were suggestive and helpful for the preoperative diagnosis.


CONCLUSIONS
Considering that prompt aggressive surgical intervention is mandatory for survival and more than 90% of aneurysmal disease with duodenal fistula formation should be within range of the endoscopists, aggressive and thorough endoscopy with a high index of clinical suspicion seems to be the most important diagnostic test in these difficult cases.
Cho
Yong Pil
YP
Department of Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Korea.
Han
Myoung Sik
MS
You
Chul Hee
CH
Kim
Seung Yong
SY
Jang
Hyuk Jai
HJ
Kim
Jee Soo
JS
Kim
Yong Ho
YH
Lee
Sung Gyu
SG
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis*; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies