A case of an aortoduodenal fistula developed three years after surgery for an abdominal aortic aneurysm

Abstract

An 80-year-old woman, who had undergone a graft replacement for an infrarenal abdominal aortic aneurysm, was admitted to the hospital because of episodes of anal bleeding in January and early March 2006. An aortoduodenal fistula was suspected, because an abdominal CT scan showed a parietal thrombus in the proximal anastomotic site and fluid collection around the graft. Further, gastrointestinal fiberscopy showed erosion in the third portion of the duodenum. The patient refused to undergo operation, and the bleeding was managed conservatively. In late March, massive hematemesis and anal bleeding occurred again, and the patient was readmitted. Conservative treatment was successful again, but curative operation was performed for prophylaxis of critical rebleeding on the 14th hospital day. During the operation, a fistula was found between the aorta and the duodenum, and primary closure of the duodenum, in-situ replacement with an artificial blood vessel, and omentopexy to prevent infection and recurrence were performed. No infection has been observed for 3 years after the surgery.