Aortoduodenalna fistula posle resekcije aneurizme abdominalne aorte

  • Aleksandar Tomić Doc. dr Aleksandar Tomić
  • 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
Ključne reči: aorta, abdominalna, aneurizma, endovaskularne procedure, krvarenje, gastrointestinalno, fistula, crevna, stentovi, lečenje, ishod, hirurgija, vaskularna, procedure

Sažetak


Uvod. Aortoenterična fistula (AEF) je retka i izuzetno teška komplikacija operacije aorte. Prikazali smo dva bolesnika sa sekundarnom aortoduodenalnom fistulom (SADF) kao komplikacijom operacije aorte. Prikazi bolesnika. U prvom slučaju SADF je nastala 11 godina nakon resekcije aneurizme abdominalne aorte, sa znacima krvarenja iz gastrointestinalnog trakta (GIT). Posle negativnog ezofagogastroduodenoskopskog (EGDS) nalaza učinjena je multislajsna kompjuterizovana tomografija (MSCT) angiografija koja je otkrila curenje kontrasta u duodenum iz 10 cm široke aneurizme visceralne aorte. Bolesnik je hitno operisan, kada je izvađen graft, redukovana aneurizma sa prešivanjem proksimalnih i distalnih delova aorte, urađena je rekonstrukcija creva i aksilobifemoralni bajpas (AxFF). Bolesnik je otpušten 30. dana posle operacije. U drugom slučaju, SADF je nastala pet meseci nakon endovaskularne rekonstrukcije abdominalne aorte (EVAR) sa znacima krvarenja iz GIT i sepse. U sledećih osam dana učinjene su tri EGDS i viđen je normalan nalaz. Na MSCT aortografiji nađeni su znaci endoleak-a, partikule slobodnog gasa u aneurizmatskoj vreći i retroaortalno, kao i znaci prisustva krvi u crevima. Bolesnik je hitno operisan i odstranjen je stent graft, ušiveni proksimalni i distalni delovi aorte, učinjena reparacija crevnog zida i AxFF. Bolesnik je egzitirao prvog postoperativnog dana zbog sepse i sindroma multiorganske disfunkcije. Zaključak. Preporučeni tretman SADF podrazumeva ekstraanatomski AxFF sa kompletnom ekscizijom inficiranog grafta ili stent grafta, prešivanje aortnih bataljaka i reparaciju duodenuma. Zbog visoke smrtnosti, kod tih bolesnika neophodna je hitna dijagnostička procena i odluka o adekvatnom operativnom tretmanu. Iako su preporuke European Society of Vascular Surgery, kao vodiča, veoma korisne, ne postoji jedinstven stav o tretmanu AEF, tako da svaki bolesnik zahteva specifičan tretman.

Reference

Kim JY, Kim YW, Kim CJ, Lim HI, Kim DI, Huh S. Successful surgical treatment of aortoenteric fistula.J Korean Med Sci 2007; 22(5): 846‒50.

Chang MW, Chan YL, Hsieh HC, Chang SS.Secondary aor-toduodenal fistula.Chang Gung Med J 2002; 25(9): 626‒30.

3. Cvjetko I. Re: Aortoduodenal Fistula Three Years After Aortobifemoral Bypass: Case Report and Literature Review. Acta Clin Croat 2017; 56(2): 349.

4. Kleinman LH, Towne JB, Bernhard VM. A diagnostic and therapeutic approach to aortoenteric fistulas: clinical experi-ence with twenty patients. Surgery 1979; 86(6): 868‒80.

Walker WE, Cooley DA, Duncan JM, Hallman GL Jr, Ott DA, Reul GJ. The management of aortoduodenal fistula by in situ replacement of the infected abdominal aortic graft.Ann Surg 1987; 205(6): 727‒32.

Reilly LM, Altman H, Lusby RJ, Kersh RA, Ehrenfeld WK, Ston-ey RJ. Late results following surgical management of vascular graft infection. J Vasc Surg 1984; 1(1): 36‒44.

Tanaka S, Kameda N, Kubo Y, Obatake N, Wakasa T, Ohsawa M, Wakasa K. Secondary aortoduodenal fistula caused on the su-ture line of the wrapping. Pathol Int 2009; 59(8): 598‒600.

Zaki M, Tawfick W, Alawy M, ElKassaby M, Hynes N, Sultan S. Secondary aortoduodenal fistula following endovascular repair of inflammatory abdominal aortic aneurysm due to Strepto-coccus anginosus infection: A case report and literature re-view. Int J Surg Case Rep 2014; 5(10): 710‒3.

Bandyk DF, Novotney ML, Back MR, Johnson BL, Schmacht DC. Expanded application of in situ replacement for prosthetic graft infection. J Vasc Surg 2001; 34(3): 411‒9; discussion 419‒20.

Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Mimidis K, Pilpilidis I, et al. Secondary aortoduodenal fistula with a fatal outcome: report of six cases. Surg Today 2005; 35(8): 677‒81.

Suzuki H, Hasegawa I, Hoshino N, Fukunaga T. Two forensic au-topsy cases of death due to upper gastrointestinal hemorrhage: a comparison of postmortem computed tomography and au-topsy findings. Leg Med (Tokyo) 2015; 17(3): 198‒200.

Witz M, Lehmann JM, Shnaker A, Pomeranz I, Leichtman G, Novis B. Secondary aortoduodenal fistula. Isr Med Assoc J 2002; 4(10): 824.

Miyamoto K, Inaba M, Kojima T, Niguma T, Mimura T. Intra-Aortic Balloon Occlusion (IABO) may be useful for the man-agement of secondary aortoduodenal fistula (SADF): A case report. Int J Surg Case Rep 2016; 25: 234‒7.

Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular sur-gery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1: S1‒S58.

Marolt U, Potrc S, Bergauer A, Arslani N, Papes D. Aortoduode-nal fistula three years after aortobifemoral bypass: case report and literature review. Acta Clin Croat 2013; 52(3): 363‒8.

Kao YT, Shih CM, Lin FY, Tsao NW, Chang NC, Huang CY. An endoluminal aortic prosthesis infection presenting as pneumoaorta and aortoduodenal fistula. World J Gastroenter-ol 2012; 18(37): 5309‒11.

Bandyk DF, Novotney ML, Johnson BL, Back MR, Roth SR. Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res 2001; 95(1): 44‒9.

Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoili-ac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg 1997; 25(2): 255‒66; discussion 267‒70.

Heikens JT, Coveliers HM, Burger DH, van Berge Henegouwen DP, Vriens PW. Saphenous vein spiral graft: successful emergency repair of a mycotic aneurysm with aortoduodenal fistula. Eur J Vasc Endovasc Surg 2006; 32(4): 408‒10.

Bacourt F, Koskas F. Axillobifemoral bypass and aortic exclu-sion for vascular septic lesions: a multicenter retrospective study of 98 cases. French University Association for Research in Surgery. Ann Vasc Surg 1992; 6(2): 119‒26.

Davidovic LB, Spasic DS, Lotina SI, Kostic DM, Cinara IS, Svet-kovic SD, et al. Aorto-enteric fistulas. Srp Arh Celok Lek 2001; 129(7‒8): 183‒93. (Serbian)

Davidović LB, Mitrić MS, Kostić DM, Maksimović ZV, Cvetković SD, Cinara IS, et al. Axillobifemoral bypass grafting. Srp Arh Celok Lek 2004; 132(5‒6): 157‒62. (Serbian)

Biancari F, Ylönen K, Anttila V, Juvonen J, Romsi P, Satta J, et al. Durability of open repair of infrarenal abdominal aortic aneu-rysm: a 15-year follow-up study. J Vasc Surg 2002; 35(1): 87‒93.

Lane JS, Barleben AR, Kubaska SM, Fujitani RM. Aortoduode-nal fistula after endovascular aneurysm repair presenting with aneurysm sac abscess. J Vasc Surg 2009; 50(4): 919‒20.

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernán-dez-Mondéjar E, et al. European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016; 20: 100.

Kozek-Langenecker SA, Ahmed AB, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe periop-erative bleeding: guidelines from the European Society of An-aesthesiology: First update 2016. Eur J Anaesthesiol 2017; 34(6): 332‒95.

Objavljeno
2021/03/04
Broj časopisa
Vol. 77 Br. 9 (2020): Vojnosanit pregl
Rubrika
Prikaz bolesnika