Olga Revilla Poza
Can Misses Hospital, SpainPresentation Title:
Screening for aortoenteric fistula in a patient with a pulsatile mass and gastrointestinal bleeding.
Abstract
An 84-year-old hypertensive, dyslipidemic, atrial fibrillation anticoagulated with acenocoumarol, congestive grade 1-11 internal hemorrhoids and colonic diverticulosis presented with general malaise, weakness and rectal bleeding of 3 days' evolution. Physical examination showing a pulsatile mass of about 5-6 cm in epigastric region with normal vitals and cardiopulmonary auscultation. Despite of this incidental discovery, an abdominal ultrasound was performed in the consultation, where a vascularized mass of about 7 cm in diameter was observed, with a possible intramural hematoma that looked like an aortic aneurysm. Blood tests and abdominal CT angiography were performed, which revealed a fusiform aneurysm with an approximate length of 95-lO0mm and a maximum anteroposterior diameter of 81mm of the infrarenal aorta, with no acute complications at the present time. Due to the trial of aortic aneurysm, pulsatile mass and melena in a hemodynamically stable patient, it was decided to rule out aortoenteric fistula by performing an upper endoscopy, which was reported as normal. During his stay in the emergency room, the patient presented an overdose of Acenocoumarol that was reversed with vitamin K and Prothromplex 1000 ul and a drop of two points in hemoglobin without hemodynamic repercussion. The patient remained in good physical condition during hos hospital stay and due to his good evolution, he was discharged with an outpatient hematology consultation to control anticoagulation, Vascular Surgery to plan a possible surgical intervention on the aneurysm, and with a Digestive tract to study gastrointestinal bleeding. A scheduled colonoscopy was performed as part of the gastrointestinal bleeding study, reporting colonic pandiverticulitis and Tubulovillous adenoma with low-grade dysplasia. Meanwhile, our outpatient is currently being studied by Vascular surgeon for possible surgical intervention of the aortic aneurysm. Patients presented with acute symptoms of gastrointestinal bleeding, aortic aneurysm and pulsatile mass, an aortoenteric fistula must to be ruled out since they have a high mortality.
Biography
Olga Revilla finished her medical degree in 2019 at the age of 23 from the Catholic University, Valencia, Spain. She took the MIR exam opting for the specialty of Family and Community Medicine, finishing the specialization in Ibiza in September 2024. Currently, she is working in the Emergency Department of the Can Misses Hospital in Ibiza (Balearic Islands, Spain) while consulting as a family doctor in several health centers and completing the Master's Degree in Emergencies and Emergencies of the Spanish Society of Emergency Medicine.
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