■ Ileus: NGT suction, bowel rest, and removal or correction of precipitating
factors
COMPLICATIONS
Strangulation of blood supply, perforation of small bowel, peritonitis, septic
shock
Aorto-Enteric Fistula
Fistula between the aorta and the bowel should be considered in all patients
with unexplained GI bleeding. The duodenum is most commonly involved.
Patients with recent aortic graft placement remain at highest risk for this com-
plication, but it may be secondary to erosion of an AAA into the bowel.
SYMPTOMS/EXAM
■ Symptoms include massive GI bleeding including hematemesis, melena,
hematochezia. A mild GI bleed may signify impending rupture with mas-
sive bleeding.
■ Rectal bleeding, decreased distal blood flow, high-output heart failure, and
hemodynamic instability may be found on exam.
DIAGNOSIS
■ Diagnosis may be difficult and may be largely based on a high level of
clinical suspicion. It may be difficult to differentiate from graft infection.
■ Upper GI endoscopy if the patient is stable
■ CT angiography may aid in identifying an associated infection.
ABDOMINAL AND GASTROINTESTINALEMERGENCIESFIGURE 11.4. Small-bowel obstruction. Plain AXR demonstrates dilated small-bowel
loops and paucity of air in the colon.
(Reproduced, with permission, from Brunicardi FC, Andersen DK, Billiar TR, Dunn DL,
Hunter JG, Pollack RE. Schwartz’s Principles of Surgery,8th ed. New York: McGraw-Hill,
2004:1027.)