Abstract
A 78-year-old man, who underwent a Y-shaped graft replacement 18 years ago for an infra-renal abdominal aortic aneurysm, was admitted to our hospital because of hematemesis and melena. An aorto-duodenal fistula was diagnosed because an abdominal computed tomography scan showed that the duodenum was deformed by an anastomotic aneurysm, which was proximal to the prosthetic vascular graft. He underwent an operation. An axillo-bifemoral bypass was performed first. A fistula between the aorta and the duodenum was observed through the aneurysm, and the fistula was closed from the inside of the aneurysm. The implanted vascular prosthesis was removed leaving the bilateral prosthetic legs, and the aortic stump was closed. Finally, an omental transfer was performed around the closed aortic stump and anastomosed prosthetic legs. The postoperative course was uneventful until the patient died from lung cancer 6 years after the operation.
