title: Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula.
abstract: This case report describes sudden massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm-duodenal fistula following mitral and aortic valvular replacement surgery due to infectious endocarditis. The superior mesenteric artery false aneurysm was diagnosed by computed tomography scanning. The intraoperative findings included a rupture at the trunk of superior mesenteric artery (SMA) and a perforation on the anterior wall of the third portion of the duodenum. The patient was treated by emergency surgery, which consisted of an interposition repair of the SMA with a saphenous vein graft for the superior mesenteric artery and a duodenojejunal Roux-en-Y anastomosis for the perforation of the duodenum. At 30-months follow-up, the patient is alive and well with no abdominal pain and eating a regular diet.
authors: Division of Vascular Surgery, West China Hospital, Sichuan, China. jichunzhao@hotmail.com
authors: Jichun
authors: J
authors: Zhao
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000785:Aneurysm, Infected / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002404:Catheterization; D004378:Duodenal Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D004696:Endocarditis / Q000150:complications* / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery