Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula.

Abstract

This case report describes sudden massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm-duodenal fistula following mitral and aortic valvular replacement surgery due to infectious endocarditis. The superior mesenteric artery false aneurysm was diagnosed by computed tomography scanning. The intraoperative findings included a rupture at the trunk of superior mesenteric artery (SMA) and a perforation on the anterior wall of the third portion of the duodenum. The patient was treated by emergency surgery, which consisted of an interposition repair of the SMA with a saphenous vein graft for the superior mesenteric artery and a duodenojejunal Roux-en-Y anastomosis for the perforation of the duodenum. At 30-months follow-up, the patient is alive and well with no abdominal pain and eating a regular diet.