A Case of Surgical Treatment for a Primary Aortoduodenal Fistula

Abstract

A primary aortic intestinal fistula is a very rare condition, and its mortality is very high without surgical treatment. A patient with a primary aortoduodenal fistula with hematemesis is presented. The patient was a 78-year-old man with a chief complaint of hematemesis. Emergency gastroduodenal endoscopic examination showed a lesion protruding into the duodenum. However, the source of bleeding was unknown, and he was referred to our hospital. Although his vital signs were stable, he had progressive anemia, and computed tomography showed an abdominal aortic aneurysm measuring 65 mm in diameter adjacent to the duodenum. Therefore, emergent surgery was performed with a diagnosis of aortoduodenal fistula. Intraoperative examination confirmed the fistula between the aortic aneurysm and the third portion of the duodenum. Abdominal aortic replacement was performed anatomically with a rifampicin-soaked prosthetic graft. The duodenal fistula was directly closed, and the pedicled omentum was used to patch between the graft and the duodenum. The patient's postoperative course was uneventful, and he was discharged on the 15th postoperative day. The antibiotics were discontinued, and there was no recurrence of infection.