Fatal Aortoduodenal Fistula Caused by a Ruptured Abdominal Aortic Aneurysm - a Case Report

Abstract

Introduction: Ruptured abdominal aortic aneurysm (AAA) has a high mortality, even when the patients reach the hospital in time and the intervention is expeditious. Case presentation: We present the case of a 66-year-old male patient, with a known history of AAA, presenting to the emergency room in a state of hypovolemic shock due to massive bleeding in the upper and lower gastrointestinal tract and acute abdominal pain, which presented an abrupt onset one hour before presentation. The computed tomography angiography identified an aortoduodenal fistula with a trajectory toward the D3 segment of the duodenum, as well as a common iliac artery occlusion and extensive atherosclerotic stigmas. The patient was rushed to the operation room where he was resuscitated with intravenous fluids, two units of packed red blood cells, and hemostatic agents. The bleeding was stopped by clamping the aorta above the aneurysm. The duodenum was sutured, and the aorta was reconstructed with an aortobifemoral graft. Unfortunately, even though intensive care procedures continued for a few hours after surgery, all therapeutic efforts failed and the patient had succumbed.

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture

“…It is one of the most lethal pathologies, occupying 13th place in the USA [ 1 ]. The dilatation may occur along the entire thoracic and abdominal aorta but generally affects the infrarenal part [ 2 , 3 , 4 , 5 ]. Among the most important risk factors for AAA are age, smoking habits, hypertension, and family history [ 6 , 7 ].…”

Innovative Technical Solution Using the Renal Artery Stump after Nephrectomy as an Inflow Artery for Lower Limb Revascularization—A Case Report

“…Still, these are recommendations for managing an aneurysm with a particular diameter (over 5.5 cm) ( 13 ). AAA has a high mortality rate and may evolve toward retroperitoneal rupture, aorto-enteric fistula formation, or spontaneous thrombosis ( 14 , 15 ).…”

“…Still, these are recommendations for managing an aneurysm with a particular diameter (over 5.5 cm) (13). AAA has a high mortality rate and may evolve toward retroperitoneal rupture, aorto-enteric fistula formation, or spontaneous thrombosis (14,15). This paper aims to present an innovative surgical technique of using the remaining renal artery, after nephrectomy, as an inflow artery for the revascularization of the critical ischemic leg, in a patient presenting with an infrarenal AAA and the occlusion of the common and external right iliac artery.…”

Polytetrafluorethylene Prosthesis Interposition in Vascular Access

“…Unfortunately, the prosthetic vascular access graft was shown to be more susceptible to infection, thrombosis, and bleeding in the long term [11,12]. In vascular surgery, grafts are used for both surgical revascularization and access vascular surgery [6,[13][14][15][16][17][18][19]. Numerous studies have been performed in recent years to monitor the biocompatibility of grafts and their resistance to infection [20][21][22].…”