Aortoduodenal fistula after abdominal aortic aneurism resection: Two case reports

Abstract

Introduction. Aortoenteric fistula (AEF) is rare and extremely difficult complication of aortic surgery. We present two cases of secondary aortoduodenal fistula (SADF) as complication after aortic surgery. Case report. First SADF happened 11 y after open abdominal aneurismal resection with GIT bleeding. After negative esophagogastroduodenoscopy (EGDS) we performed Multi Detector Computed Tomography (MDCT) with visualization of contrast leakage in duodenum from 10 cm wide visceral aortal aneurism. Unstable patient was treated with graft excision, aneurismal reduction, sewing of proximal and distal aortal stumps, bowel repair followed by axillobifemoral bypass (AxFF). Patient dismissed on 30 postoperative day. Second case of ADF happens five months after endovascular reconstruction of abdominal aorta (EVAR) with GIT bleeding and fewer. In 8 days, he had 3 negative EGDS. On MDCTwe find signs of endoleak, free air in aneurysmal sac, and signs of blood in intestine. On urgent operation we extracted stent graft, sew proximal and distal aortal stumps, do bowel repair and AxFF.Patientdied a day after operation with signs of sepsis and Multy Organ Failure Syndrome (MOFS). Conclusion. Conventional treatment of ADF means extra-anatomic AxFF with complete excision of infected graft or stent graft, with closure of aorta's proximal and distal stump and duodenal repair. Because of high mortality, prompt diagnostic evaluation and quick decision of adequate operative treatment is necessary. Although ESVS recommendations as a guide are very helpful there is no unique attitude about management of AEF, so each patient has his own specific treatment.