Thu Duc Regional General Hospital said it has just received a 63-year-old female patient (residing in Dong Hoa ward, Ho Chi Minh City) admitted to the hospital with symptoms of vomiting blood red bruises accompanied by dizziness and severe fatigue. The patient has a history of diabetes, high blood pressure, dyslipidemia and regularly uses pain relievers due to bone and joint diseases.
Upon admission, the patient's condition temporarily stabilized with blood pressure 100/60 mmHg, pulse 89 beats/minute, still conscious, epigastric pain. Emergency gastric endoscopy was performed but no bleeding points were detected. Faced with the abnormal situation, doctors prescribed abdominal angiography.
The results showed that the patient had a sac-like abdominal aortic aneurysm just below the renal artery. After a short time, the condition progressed rapidly: pale skin, pale mucous membranes, bright red stools, pulse increased 116 times/minute, blood pressure dropped to 80/40 mmHg, signs of blood loss shock.
Recognizing the possibility of an aortic and duodenal leakage, a rare but extremely dangerous complication, the team urgently consulted and took the patient to the operating room. In surgery, doctors determined that the aneurysm had ruptured and entered the D3 segment of the duodenum, causing massive gastrointestinal bleeding. The patient was sewn the puncture and the aortic segment was replaced with an artificial graft.
The surgery lasted nearly 7 hours, performed by the Thoracic Surgery - Vascular Surgery team in coordination with Anesthesia and Resuscitation. After surgery, the patient was actively monitored and is now awake, with stable health, expected to be discharged soon.
According to Dr. Du Minh Nga - Department of Urology, Thoracic Surgery - Thu Duc Regional General Hospital, aortic and duodenal fistula is a very rare complication of abdominal aortic aneurysm but has a high mortality rate. Notably, the disease can start with a mild bleeding episode, a warning sign before progressing to massive bleeding. In many cases, gastrointestinal endoscopy does not detect the cause, while angiography plays a key role in diagnosis.
From this case, doctors recommend that elderly people with underlying cardiovascular disease, when vomiting blood or bloody stools appear, need to go to a medical facility immediately, and should not be subjective. Early diagnosis, multi-specialized coordination and timely intervention are decisive factors to help save the patient's life.
