Abstract
Introduction: An aortoduodenal fistula is a potentially lethal complication after transperitoneal open repair of an abdominal aortic aneurysm. Case Report: A 77-year-old Caucasian male who underwent a conventional repair of an inflammatory infrarenal aortic aneurysm, was readmitted with hematemesis only six weeks after surgery. Gastroscopy and computed tomography angiography indicated an aortoduodenal fistula and urgent aortic reconstruction was performed. An aortoduodenal fistula is a potentially lethal complication after transperitoneal open repair of an abdominal aortic aneurysm. Conclusion: An aortoduodenal fistula seldom occurs as early after conventional transperitoneal open aneurysm repair as in our case. The early occurrence of the aortoduodenal fistula can be explained by the inflammatory character of the aneurysm.
Highlights
An aortoduodenal fistula is a potentially lethal complication after transperitoneal open repair of an abdominal aortic aneurysm
Case Report: A 77-year-old Caucasian male who underwent a conventional repair of an inflammatory infrarenal aortic aneurysm, was readmitted with hematemesis only six weeks after surgery
The early occurrence of the aortoduodenal fistula can be explained by the inflammatory character of the aneurysm
Summary
An aortoduodenal fistula was first described by Sir Astley Cooper in 1829 and is defined as an abnormal communication between the aorta and duodenum [1]. Medical history of the patient included diabetes mellitus type 2, a peritonitis after appendicitis and peripheral artery occlusive disease (PAOD) stage 2a. Six weeks earlier, he underwent a conventional transperitoneal repair of an inflammatory infrarenal aortic aneurysm measuring 7.6 cm in diameter. No clear contrast extravasation in the duodenum was seen on this scan, an aortoduodenal fistula was presumed because of the very close proximity of the duodenum to the aorta and the air bubbles in and around the aneurysm sac and the signs of local bowel wall thickening. An urgent aortic reconstruction was performed with a graft constructed from the right superficial femoral vein according to Nevelsteen (Figure 2) [3]. Permission for a postmortem examination was declined by the relatives
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