CASE REPORTS  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 2000 February;41(1):113-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Primary aortoduodenal fistula complicated by abdominal aortic aneurysm

Korkut A. K. *, Arpinar E. **, Yasar T., Guney D. **

From the Dept. of Thoracic and Cardiovascular Surgery Vakif Gureba Hospital, Istanbul *Dept. of Thoracic and Cardiovascular Surgery Medical Faculty of Istanbul - University, Istanbul **Dept. of General Surgery Vakif Gureba Hospital Istanbul, Turkey

A 74-­year-old ­male ­patient was oper­ated in ­Vakif ­Gureba Hos­pital for aor­tod­u­od­enal fis­tula devel­oping ­from abdom­inal ­aortic aneu­rysm. The ­patient was diag­nosed as abdom­inal ­aortic aneu­rysm ­after phys­ical exam­ina­tion and com­puted tomog­raphy in ­another ­center. ­Appearing of ­melena and hem­a­tem­esis gas­tro­du­o­de­nos­copy and radio­nu­clide scan­ning was per­formed as diag­nosis. ­After 6 ­days gas­troin­tes­tinal ­bleeding ­recurred in mas­sive hae­mor­rhage and the ­patient was oper­ated ­with a diag­nosis of aor­toen­teric fis­tula as emer­gency. A mid­line lap­a­rotomy was per­formed. ­There was a fis­tula ­between infra­renal abdom­inal ­aortic aneu­rysm (with diam­eter 8×10 cm) and the 3rd por­tion of the duod­enum. The duod­enum was ­resected seg­mental and the fis­tula was dis­con­nected. Fol­lowing aneu­rys­motomy a pros­thetic ­graft was ­placed in the aor­to­bii­liac posi­tion. The ­patient was dis­charged at the 42nd post­op­er­a­tive day. Pri­mary aor­toen­teric fis­tula is a ­very ­rare con­se­quence of ­untreated abdom­inal ­aortic aneu­rysm. The seg­ments of intes­tine ­most fre­quently ­involved in aor­toen­teric fis­tula are the 3rd and 4th por­tions of the duod­enum. Clin­ical pres­en­ta­tion is recur­rent epi­sodes of ­gross gas­troin­tes­tinal hae­mor­rhage. ­These ­cases ­have ­high mor­tality and mor­bidity ­unless eval­u­ated as ­quickly as pos­sible and appro­priate sur­gical inter­ven­tion per­formed.