[A woman with hemorrhagic shock].
BACKGROUND
Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action.


METHODS
We present an 82-year-old female patient with haematemesis, who during the first few minutes after admission developed haemorrhagic shock. At emergency laparotomy, a profuse bleeding in the duodenum was found. During surgery the patient developed cardiovascular collapse and died. The patient had a previous diagnosis of duodenal ulcer. She was, furthermore, diagnosed with an abdominal aortic aneurysm developing at the cranial anastomosis of an aorto-bifemoral bypass performed seventeen years earlier. An autopsy was performed and confirmed the clinical suspicion of an aorto-duodenal fistula.


CONCLUSIONS
An aorto-enteric fistula represents a direct communication between the aorta and the intestinal lumen; it can be primary or secondary. Secondary aorto-enteric fistulae are complications of reconstructive procedures on the abdominal aorta. Based on register data, approximately three patients with this condition could be expected per year in Norway (incidence 1.6 %). Patients with severe gastric-intestinal bleeding and previous aortic reconstruction represent an identifiable group that should be referred directly to hospitals with competence in vascular surgery.
Mundal
Liv
L
Medisinsk avdeling, Førde sentralsjukehus, 6807 Førde. livmun@hotmail.com
Ignjatovic
Dejan
D
Våge
Villy
V
Asmussen
Inger
I
Sund
Ståle
S
D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications / Q000209:etiology; D004381:Duodenal Ulcer / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000209:etiology; D006396:Hematemesis / Q000175:diagnosis; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000601:surgery; D016157:Vascular Fistula / Q000150:complications / Q000209:etiology; D014656:Vascular Surgical Procedures