ABSTRACT
PURPOSE: Duodenal obstruction caused by aneurysmal dilatation of the abdominal aorta is a rare clinical entity that is traditionally treated by open aneurysm repair, aneurysmorrhaphy, and duodenal release. We present here the case of aortoduodenal syndrome treated by endovascular therapy. CASE REPORT: A 73-year-old man diagnosed simultaneously with sigmoidovesical fistula and an abdominal aortic aneurysm (AAA) underwent resection of the sigmoid colon followed by colostomy. On postoperative day 34, the patient experienced nausea and vomiting. Computed tomography revealed the AAA causing duodenal obstruction by direct compression. We chose endovascular therapy for treating the AAA rather than graft replacement because of the risk of infection by the colostomy orifice. Postoperatively, the patient reacquired the ability to eat. However, postoperative computed tomography revealed that the diameter of the AAA had not changed. CONCLUSIONS: We considered that the decreased intra-aneurysmal pressure caused a release of duodenal obstruction.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Decompression, Surgical/methods , Duodenal Obstruction/surgery , Endovascular Procedures , Aged , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Aortography/methods , Decompression, Surgical/instrumentation , Duodenal Obstruction/diagnosis , Duodenal Obstruction/etiology , Endovascular Procedures/instrumentation , Humans , Male , Stents , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
PURPOSE: We investigated the influence of intraoperative continuous tranexamic acid (TA) infusion on the amount of blood transfusion required in emergency surgery for type A acute aortic dissection. METHODS: The study was based on the data of 55 consecutive patients who underwent surgery for type A acute aortic dissection. The patients were divided into 2 groups for comparison: Group T, consisting of 26 patients who received intraoperative continuous infusion of TA, and Group N, consisting of 29 patients who did not receive TA infusion during the surgery. RESULTS: The mean amounts of blood transfusion required during and after surgery were compared between the 2 groups: they were 10.5 ± 8.7 and 16.2 ± 10.0 units of mannitol-adenine-phosphate-added red cell concentrate, 9.3 ± 8.6 and 17.1 ± 10.0 units of fresh frozen plasma, and 20.4 ± 12.2 and 29.7 ± 14.9 units of platelet concentrate, respectively, in Groups T and N. Thus, the amount of each of these blood products required was significantly reduced in Group T. CONCLUSIONS: During emergency surgery for type A acute aortic dissection, continuous infusion of TA resulted in a significant reduction in the amount of blood transfusion required.
Subject(s)
Antifibrinolytic Agents/administration & dosage , Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Loss, Surgical/prevention & control , Blood Vessel Prosthesis Implantation , Tranexamic Acid/administration & dosage , Acute Disease , Aged , Aortic Dissection/blood , Aortic Dissection/diagnosis , Antifibrinolytic Agents/adverse effects , Aortic Aneurysm, Thoracic/blood , Aortic Aneurysm, Thoracic/diagnosis , Blood Transfusion , Blood Vessel Prosthesis Implantation/adverse effects , Emergencies , Female , Humans , Infusions, Parenteral , Male , Middle Aged , Retrospective Studies , Tranexamic Acid/adverse effects , Treatment OutcomeABSTRACT
An 84-year-old man was transferred to the emergency department for the treatment of shock. His upper body was swollen. Hematoma from the ruptured brachiocephalic artery aneurysm was compressing and obstructing the superior vena cava (SVC). A stent graft was deployed from the brachiocephalic artery to the right common carotid artery, and the proximal right subclavian artery was coil embolized. On postoperative day 5, when his neck swelling subsided and tracheal stenosis seemed resolved, the patient was extubated and the subsequent recovery was uneventful. He was discharged from the hospital on postoperative day 24. Although the stent grafting does not directly decompress the SVC by removing aneurysm and hematoma, it seems to be the treatment option for the morbid patients.
