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The Journal of Cardiovascular Surgery 1999 February;40(1):31-5

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Primary aorto-duodenal fistula secondary to infected abdominal aortic aneurysms: the role of local debridement and extra-anatomic bypass

Pagni S., Denatale R. W., Sweeney T., McLaughlin C., Ferneini A. M.

From the Hospital of Saint Raphael Division of Vascular Surgery Department of Surgery, New Haven, Connecticut, USA


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Gastrointestinal bleed­ing sec­on­dary to spon­ta­ne­ous rup­ture of an infect­ed abdom­i­nal aor­tic aneu­rysm ­into the duod­e­num is a ­rare and high­ly ­lethal clin­i­cal occur­rence, rep­re­sent­ing rough­ly a ­third of all pri­mary aor­tod­u­od­en­al fis­tu­las. Diagnosis is prob­le­mat­ic due to the sub­tle­ties in the clin­i­cal pres­en­ta­tion and ­course, and sur­gi­cal treat­ment is usu­al­ly ­delayed, rep­re­sent­ing a chal­lenge ­even for the expe­ri­enced vas­cu­lar sur­geon. The over­all mor­tal­ity is ­over 30% and the oper­a­tive approach­es are ­still con­tro­ver­sial. Two cas­es of rup­tured infra­ren­al aor­tic aneu­rysms com­pli­cat­ed ­with aor­tod­u­od­en­al fis­tu­la ­were recent­ly treat­ed at our insti­tu­tion. Bacterial aor­titis was doc­u­ment­ed by arte­ri­al ­wall cul­tures pos­i­tive for Klebsiella and Salmonella spe­cies respec­tive­ly. The clin­i­cal cours­es and out­comes of the two ­patients (one sur­vi­vor ) treat­ed ­with ret­ro­per­i­to­neal debride­ment and ­extra-ana­tom­ic ­bypass and a ­review of the mod­ern sur­gi­cal treat­ment are here­in ­described.

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