Massive gastrointestinal hemorrhage in combat casualties and trauma victims secondary to arterio-visceral fistulas
Massive upper gastrointestinal bleeding is a known complication of advanced sepsis in trauma patients and carries a grave prognosis. However, to our knowledge, an important cause of massive gastrointestinal bleeding, arterio-visceral fistula has not been discussed in the literature. The most common cause of this unique clinical entity is penetrating high velocity abdominal injuries, although blunt trauma may also be responsible. Due to partial injury of the major intra-abdominal vessels, a false aneurysm is formed. The intra-abdominal false aneurysm, causing pressure necrosis in the intestinal wall, perforates into the gut with massive hemorrhage. Characteristics of this hemorrhage include its massive and bright red nature, recurrence and curability with correct diagnosis and appropriate treatment. Our experience with sixteen cases, clinical presentation, diagnostic features and surgical treatment is discussed in this paper.