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Acute Jejunal Perforation

Leonard E. Reaves III, MD; Francis E. McDonough, MD; Jerome K. Jerome
JAMA. 1965;193(8):688. doi:10.1001/jama.1965.03090080050024.
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To the Editor:—  Arteriosclerotic aneurysms of the abdominal aorta are being treated successfully by resection of the involved segment and the reestablishment of continuity with prosthetic grafts. Recent reports describing the long-term results have directed attention to the serious and possibly preventable late sequelae, such as erosion of the retroperitoneal portion of the duodenum by the aortic replacement,1 aortic-enteric fistula,2 intestinal ischemic necrosis,3 and small bowel obstruction.This communication concerns a patient in whom an acute perforation of the jejunum developed 12 months after removal of an aneurysm as the result of silent pressure necrosis of the portion of bowel adherent to the Dacron graft. A 58-year-old housewife had a fusiform abdominal aortic aneurysm resected and replaced by a Dacron graft of the bifurcation type. Twelve months later she experienced a sudden episode of knifelike periumbilical pain, nausea, sweating, and profound weakness which lasted 12 hours. Surgical


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