Aorto-enteric fistula and Murphy's law
DOI:
https://doi.org/10.19230/jonnpr.3727Keywords:
Aortoenteric fistula, aortoduodenal fistula, secondary aortoenteric fistula, secondary aortoduodenal fistula, graft-enteric fistulas, paraprosthetic fistula, graft-enteric erosionsAbstract
Objective. To reflect our frustration when losing a patient, not because their infrequent pathology is in itself very serious, but because of the accumulation of other diagnostic and therapeutic reasons in a hospital environment of the Covid-19 epidemic.
Method. First we describe the diagnostic, therapeutic and evolutionary process (February 27 to March 25, 2020) of a 73-year-old male with an aorto-enteric fistula secondary to an aorto-bifemoral bypass, implanted twelve years earlier in another hospital. Then we present our experience (1978-2020) in this type of situation, and finally we carried out a review of the literature (1953-2020) in this regard.
Results. A) Clinical case: absence of early diagnosis, failure of the chosen operative technique, significant postoperative complications (hemorrhage, cerebral infarction and bilateral coronavirus pneumonia) that ended in death. B) Personal experience: four cases (including the referred one). C) Literature review: three systematic reviews: 564 cases (1953-1993); 386 cases in 58 publications (1991-2006), 823 patients in 216 publications (1995-2015) and 20 cases in 14 publications (2016-2020).
Conclusion. If in normal situations an aorto-enteric fistula is a condition that seriously threatens the patient's life (hemorrhage and / or infection), it should not be surprising that in exceptional situations this serious situation increases. However, from these bad experiences we are obliged to draw lessons that will benefit others in the future.
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