Fatal hemorrhage from a gastroaortic fistula secondary to gastric ulceration associated with Nissen fundoplication and nonsteroidal anti-inflammatory drug use.
Acute gastrointestinal hemorrhage from a gastroaortic fistula in the gastric fundoplication pouch is a rare complication of Nissen fundoplication. The present case reports a gastroaortic fistula secondary to gastric ulceration associated with prior Nissen fundoplication and nonsteroidal anti-inflammatory drug use. A 55-year-old man presented with massive hematemesis and died of exsanguination during emergency laparotomy. Recognition of factors that predispose a patient to gastric ulceration after fundoplication, including nonsteroidal anti-inflammatory drug use, is critical to arouse the high index of suspicion required to diagnose and manage this life-threatening complication.
Manduch
M
M
Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada.
Rossiter
J P
JP
Depew
W T
WT
Mercer
C Dale
CD
Hurlbut
D J
DJ
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001018:Aortic Diseases / Q000150:complications / Q000209:etiology*; D017809:Fatal Outcome; D018662:Fundoplication / Q000009:adverse effects*; D005747:Gastric Fistula; D005764:Gastroesophageal Reflux / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013276:Stomach Ulcer / Q000139:chemically induced / Q000150:complications / Q000209:etiology*; D016157:Vascular Fistula / Q000150:complications / Q000209:etiology*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin