Improvements in the diagnosis and management of aortoenteric XXXX .

@entity1 @entity295 @entity292 @entity439 @entity360
To assess the impact of an aggressive approach (early operation, graft removal, and extraanatomic bypass) adopted by us 5 years ago in @entity1 with aortic synthetic grafts and @entity360 , we reviewed our 15 year experience with aortoenteric @entity292 in 13 @entity1 . The courses of six @entity1 from the recent series (1979 through 1984) were contrasted with those of seven @entity1 from our earlier series (1968 through 1978). Twelve of 13 @entity1 presented with @entity360 (usually low volume), and no @entity1 presented in shock. Six of seven @entity1 in Series I (earlier series) had positive blood cultures, whereas only two of six in Series II (recent series) had this finding. Of the 13 @entity1 , 10 underwent preoperative endoscopy. It was only with consistent visualization of third and fourth portions of the duodenum that a diagnosis of aortoenteric @entity292 was established (three of four @entity1 75 percent). Although the upper gastrointestinal series was abnormal more frequently (five of seven @entity1 , 71 percent) than arteriograms (three of nine @entity1 , 33 percent), the latter was more specific for a predisposing lesion. At surgery, nine (70 percent) @entity1 had an anastomotic @entity292 and four (30 percent), a false @entity439 . Although only one of seven @entity1 in Series I survived (14 percent), four of six @entity1 in Series II were alive at last follow-up in September 1984 (67 percent). Early diagnosis followed by prompt operation with removal of the synthetic graft and extraanatomic bypass is associated with an improved survival for @entity1 with aortoenteric @entity292 , but the degree of @entity295 as indicated by positive blood cultures appears to be an important prognostic sign.
