A Modification of the Treatment of Prosthetic Graft Infection Complicating an Aorto-Duodenal Fistula

Abstract

The replacement of infected prosthetic graft material, usually bifurcated abdominal aortic grafts associated with aorto-duodenal fistulæ, is a difficult surgical procedure. In this paper, an original modification of the surgical treatment of a secondary aorto-duodenal fistula in four cases is presented. An oblique incision from the left costal arch to the right antero-superior iliac spine and retroperitoneal approach was used. In this way the retroperitoneal space was exposed and the aorto-duodenal fistula was dissected. The duodenal fistula was closed with two layers of stitches and additionally protected with a pedicle of the greater omentum, placed retrocolically in the retroperitoneal space.