Abstract
Pseudoaneurysm-enteric fistulas after graft replacement of abdominal aortic aneurysm (AAA) are relatively rare. An 83-year-old man who underwent graft replacement of AAA complained of melena during follow-up. Upper gastrointestinal scopy revealed a raised lesion that resembled a submucosal tumor at the distal third portion of the duodenum and adhesion of blood to the top. Computed tomography showed a high density area that suggested aortoduodenal fistula. Therefore, he underwent urgent exploratory laparotomy. On operative view, the proximal jejunum near the ligament of Treitz adhered tightly to the residual aneurismal wall and the wall formed a pseudoaneurysm-jejunal fistula. The pseudoaneurysm-jejunal fistula was resected en bloc. We irrigated the abdominal cavity with saline, performed omentopexy and wrapped the graft with the aneurysmal wall. The postoperative course was uneventful and he was discharged on the 17th postoperative day. Simple closure of fistula and omentopexy may be useful in cases of secondary aortoenteric fistulas that have no graft infection.
