| A Case of
Graft Duodenal Fistula Occurring after Operation for Thoracoabdominal
Aortic Pseudoaneurysm Associated with Behçet's Disease |
(First Department of Surgery, Chiba University School
of Medicine, Chiba, Japan)
| Toshiaki Ohto |
Masahisa Masuda |
Naoki Hayashida |
| Yoko Pearce |
Mitsuru Nakaya |
Hitoshi Shimura |
| Kenji Mogi |
Nobuyuki Nakajima |
|
|
A 41-year-old
woman was given a diagnosis of Behçet's disease at age 25. When
she was 31, a large aortic pseudoaneurysm developed near the
left renal artery. Isolation of the aneurysm and anatomical grafting
and ancillary bypass were performed. Ten years later, a graft
duodenal fistula developed. Extra-anatomical reconstruction was
done after complete resection of the original graft and the infectious
lesion. It was found that the intra-abdominal organs were receiving
blood supply only from the inferiol mesenteric artery. Moreover,
severe ischemia of the intra-abdominal organs was a concern during
surgery. Therefore, hepatic vein oxygen saturation was monitored
continuously with a Swan-Ganz catheter for ischemia of the intra-abdominal
organs. It proved to be a very effective indicator and we could
perform this operation safely. Reoperation of grafting is often
inevitable in patients with Behçet's disease. Also, two stumps
of abdominal aorta were left in this patient because of the extra-anatomical
reconstruction. Pseudoaneurysm may later occur at the site of
the stumps, thus necessitating careful follow-up observations.
Jpn. J. Cardiovasc. Surg. 31：337-340 (2002) |
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