ABSTRACT
Aortoenteric fistula is a rare and life-threatening cause of upper gastrointestinal hemorrhage. Fistulas may be classified as primary or secondary. Secondary aortoenteric fistulas usually occur at the suture line following arterial reconstruction with prosthetic material and developed in 0.5~2.4% of the patients. The incidence of primary fistulas was reported in 0.04~0.07% in a large autopsy series and is 0.69~2.36% in patients with abdominal aortic aneurysm. Atherosclerosis is now the dominant cause. The mortality rate of patients with primary aortoduodenal fistula (ADF) is extremely high, principally because the diagnosis is difficult and seldomly established before the massive bleeding results in emergency operation or death. This occurs predominantly in the third and fourth parts of the duodenum. Symptoms of ADF consist of flank pain or abdominal pain, hematemesis, melena, and an abdominal mass. ADF is curable, if diagnosed and treated with surgical intervention before the onset of lethal massive hemorrhage. We report a case of primary ADF with a review of the literatures.
Subject(s)
Humans , Abdominal Pain , Aortic Aneurysm, Abdominal , Atherosclerosis , Autopsy , Diagnosis , Duodenum , Emergencies , Fistula , Flank Pain , Gastrointestinal Hemorrhage , Hematemesis , Hemorrhage , Incidence , Melena , Mortality , SuturesABSTRACT
BACKGROUND: Although the incidence of tsutsugamushi disease has been increasing in Korea, epidemiological and clinical characteristics of tsutsugamushi disease in Young?dong province have not been reported. METHODS: We retrospectively reviewed the medical records of 46 patients of tsutsugamushi disease who admitted at Gangneung Asan hospital from 1997 to 2001. RESULTS: Incidence of tsutsugamushi disease in Young-dong province had been increasing since 1999. Most patients were infected during agricultural work. The incidence of women was higher than that of men (65.2%). Characteristic laboratory finding was elevation of AST and ALT, hypoalbuminemia and thrombocytopenia. Despite fever, leukocytosis was found only in 20% of patients. Course of disease was relatively good in most patients, but complications such as pneumonia, acute renal failure, and shock developed in 26% of patients. In one case with acute renal failure and another case with pneumonia, the patients' condition aggravated in spite of doxycycline therapy, thus, hemodialysis and mechanical ventilator care were done respectively. Consequently, both patients recovered completely without chronic complication. Old age (>65 years), longer duration from onset of symptoms to admission (>10 days), hypoalbuminemia at admission(<2.6 g/dL) and leukocytosis could be used as a marker for prediction of complications. CONCLUSION: Incidence of tsutsugamushi disease increased in Young?dong region. Old age, delayed admission, hypoalbuminemia and leukocytosis could be used as marker for prediction of complications.
Subject(s)
Female , Humans , Male , Acute Kidney Injury , Doxycycline , Fever , Hypoalbuminemia , Incidence , Korea , Leukocytosis , Medical Records , Pneumonia , Renal Dialysis , Retrospective Studies , Scrub Typhus , Shock , Thrombocytopenia , Ventilators, MechanicalABSTRACT
BACKGROUND: Although the incidence of tsutsugamushi disease has been increasing in Korea, epidemiological and clinical characteristics of tsutsugamushi disease in Young?dong province have not been reported. METHODS: We retrospectively reviewed the medical records of 46 patients of tsutsugamushi disease who admitted at Gangneung Asan hospital from 1997 to 2001. RESULTS: Incidence of tsutsugamushi disease in Young-dong province had been increasing since 1999. Most patients were infected during agricultural work. The incidence of women was higher than that of men (65.2%). Characteristic laboratory finding was elevation of AST and ALT, hypoalbuminemia and thrombocytopenia. Despite fever, leukocytosis was found only in 20% of patients. Course of disease was relatively good in most patients, but complications such as pneumonia, acute renal failure, and shock developed in 26% of patients. In one case with acute renal failure and another case with pneumonia, the patients' condition aggravated in spite of doxycycline therapy, thus, hemodialysis and mechanical ventilator care were done respectively. Consequently, both patients recovered completely without chronic complication. Old age (>65 years), longer duration from onset of symptoms to admission (>10 days), hypoalbuminemia at admission(<2.6 g/dL) and leukocytosis could be used as a marker for prediction of complications. CONCLUSION: Incidence of tsutsugamushi disease increased in Young?dong region. Old age, delayed admission, hypoalbuminemia and leukocytosis could be used as marker for prediction of complications.
