Aortoduodenal fistula after abdominal aortic aneurysm resection:  Two case reports

Aleksandar Tomić; Ivan Marjanović; Zoran Kostić; Miroslav Mitrović; Damjan Slavković; Igor Vasković; Aleksandar Jevtić; Dragan Sekulić

doi:10.2298/VSP180914162T

Aleksandar Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Ivan Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
Zoran Kostić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Miroslav Mitrović Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
Damjan Slavković Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
Igor Vasković Military Medical Academy, Clinic for Anesthesia and Intensive Care, Belgrade, Serbia
Aleksandar Jevtić Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade, Serbia
Dragan Sekulić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180914162T

Keywords: aortic aneurysm, abdominal, endovascular procedures, gastrointestinal hemorrhage, intestinal fistula, stents, treatment outcome, vascular surgical procedure

Abstract

Introduction. Aortoenteric fistula (AEF) is rare and extremely difficult complication of aortic surgery. We presented two cases of secondary aortoduodenal fistula (SADF) as complication after aortic surgery. Case reports. In the first patient SADF happened 11 years after open abdominal aneurysmal resection with gastrointestinal tract (GIT) bleeding. After negative esophagogastroduodenoscopy (EGDS) we performed multislice computed tomography (MSCT) which revealed contrast leakage in duodenum from 10 cm wide visceral aortic aneurysm. The patient was treated with graft excision, aneurysmal reduction, sewing of proximal and distal aortal stumps, bowel repair followed by axillobifemoral bypass (AxFF). The patient dismissed on 30th postoperative day. The second case of ADF happened five months after endovascular reconstruction of abdominal aorta with GIT bleeding and fewer. During following 8 days, he had three negative EGDS. On MSCT we found signs of endoleak, free air in aneurysmal sac, and signs of blood in the intestine. On urgent operation we extracted stent graft, sewed proximal and distal aortal stumps, performed bowel repair and AxFF. The patient died a day after operation with signs of sepsis and multiple organ failure syndrome. Conclusion. Conventional treatment of ADF means extraanatomic AxFF with complete excision of infected graft or stent graft, with closure of aorta’s proximal and distal stumps and duodenal repair. Because of high mortality, prompt diagnostic evaluation and quick decision of an adequate operative treatment is necessary. Although European Society of Vascular Surgery recommendations, as a guide, are very helpful, there is no unique attitude about management of AEF, so each patient should be specifically treated.

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