Abstract
An aortoenteric fistula (AEF) is a complication of an untreated inflammatory abdominal aortic aneurysm (AAA) which can cause life-threatening gastrointestinal (GI) bleeding. We successfully treated a patient with an AEF, and report this case. A 65-year-old man was referred to us because of massive melena and loss of consciousness. Emergency gastroduodenal fiberscopic examination revealed a bleeding focus at a site opposite the papilla of Vater. Intravenous contrast-enhanced abdominal computed tomography (CT) scans were performed. We diagnosed AEF and the patient underwent emergency surgery. Intraoperatively, we confirmed the presence of an aortoenteric fistula between an abdominal aortic aneurysm and the duodenum. We performed an en-bloc resection of the duodenum and abdominal aortic aneurysm wall, followed by in-situ aortic reconstruction. In order to reduce the risk of infectious complications such as a graft infection, a pedicled omentum was used to cover the prosthetic graft. His postoperative course was uneventful, he was discharged 36 days later, and there has been no evidence of infection during the following 18 months. In conclusion, early diagnosis and prompt surgical treatment is essential in such cases of aortoenteric fistula.
