Abstract
We report a case of secondary aortoduodenal fistula which occurred 5 years after an abdominal aortic aneurysm repair. A 54-year-old man was admitted with sudden loss of consciousness after massive hematemesis. He underwent Y-graft replacement for abdominal aortic aneurysm 5 years previously. Computed tomography scanning demonstrated adhesion of the aorta-duodenum at the proximal anastomosis of the prosthetic graft and angiography showed a leakage of contrast medium in the region of the infrarenal aorta. An emergency operation was performed under a diagnosis of a secondary aortoduodenal fistula. At laparotomy the duodenum was firmly attached to the pseudoaneurysm and a fistulous communication was also observed at the site of proximal anastomosis. After the duodenal defect was closed following excision of the contaminated graft, operative reconstruction was performed via the anatomical route using the interposition of a new prosthetic graft, and the greater omentum was used to fill defects surrounding the anastomosed site. His postoperative course was uneventful, he has been doing well for 9 years.
