Abdominal Vascular Catastrophes

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Section snippets

Key points

  • Mesenteric ischemia (MI) has a variety of causes, each with its own historical clues to assist in diagnosis.

  • Early CT angiography without waiting for administration of oral contrast should be pursued in suspected cases of MI.

  • Unexplained hypotension, syncope, or ecchymosis should prompt consideration of ruptured abdominal aortic aneurysm (AAA).

  • Any amount of gastrointestinal (GI) bleeding in a patient with a history of AAA or AAA repair is an aortoenteric fistula (AEF) until proved otherwise.

Anatomy/Pathophysiology

A true aneurysm is a

Pathophysiology

The disease is divided into 2 types – primary AEF and secondary AEF. Although uncommon, primary AEF occurs when a large, previously untreated aneurysm erodes de novo into the adjacent bowel. This is often diagnosed unexpectedly during exploratory laparotomy. The third portion

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References (36)

Cited by (7)

  • Extraabdominal Rupture of an Inflammatory Abdominal Aortic Aneurysm in a Patient With Aortodecubital Fistula: A Case Report

    2021, Annals of Vascular Surgery
    Citation Excerpt :

    Upon autopsy, a thin fistula from the AAA communicating with the sacral decubitus ulcer was found. Spontaneous rupture AAA through skin is an extremely rare and potentially fatal occurrence.1,2 The development of arteriovenous, aortobronchial, aortoesophageal, aortoduodenal, aortoenteric, aortosigmoid, and aortoappendicular fistulas has been previously described in several case reports.3-8

  • Vascular Etiologies of the Acute Abdomen

    2020, Seminars in Roentgenology
    Citation Excerpt :

    Appropriate imaging is essential for accurate diagnosis. Patients with known aortic aneurysms should raise a higher degree of concern as larger aneurysm size and faster rate of aneurysm growth are associated with greater risk of rupture.71 US is often used in as a screening modality to identify AAA in asymptomatic patients and bedside US can also serve as an initial diagnostic tool to aid in identifying aneurysms in the acute setting in an unstable patient.71,73

  • Care of Acute Gastrointestinal Conditions in the Observation Unit

    2017, Emergency Medicine Clinics of North America
    Citation Excerpt :

    High-risk conditions should be thoroughly considered in patients with risk factors before placement in the EDOU. One example is consideration of mesenteric ischemia in patients with a history of atrial fibrillation, cardiomyopathy, and other low-flow states.10 The provider should consider that several emergent conditions may initially appear to have a GI etiology.

  • What Is the Ideal Imaging Strategy for Diagnosing AAA, Abdominal Aortic Dissection, and Aortic Rupture?

    2019, Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions
View all citing articles on Scopus

Disclosure Statement: The authors have no financial relationships to disclose.

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