Two Cases of Secondary Aorto-duodenal Fistula Treated with Abdominal Aortic Re-replacement by an Ingenious Intestinal Reconstructive Pathway

Abstract

Aorto-duodenal fistula after abdominal aortic replacement is a rare but fatal complication. In principle, surgical treatment is necessary. However, standard method of treatment has not yet been established. In cases in which the duodenum has formed a fistula due to contact with the prosthetic graft, leaving the duodenum in the anatomic pathway is considered a high risk of recurrence. Therefore, it is important not only to repair the duodenum and but also to avoid contact with the prosthetic graft to prevent recurrence. We report two cases who developed secondary aorto-duodenal fistula after artificial vessel replacement for abdominal aortic aneurysm, who underwent abdominal aortic re-replacement, partial duodenal resection, and duodenal jejunal anastomosis with posterior jejunal colon path reconstruction. The first case was treated with omental flap transposition at the same time, and in the other case omental flap could not be used because of the lack of enough tissue. However, both cases had a good clinical course without recurrence of infection. This method of altering the route of intestinal reconstruction does not allow the artificial vessel to come into direct contact with the duodenum and may be effective in preventing recurrent infection.