Secondary aortoduodenal fistula

Area of Science:

• Vascular Surgery
• Gastroenterology
• Surgical Complications

Background:

• Aorto-enteric fistulae (AEF) are rare but life-threatening complications following aortic reconstruction.
• Aorto-duodenal fistulae (ADF), a subtype of AEF, account for 80% of cases and typically present with upper gastrointestinal bleeding.
• Secondary ADF can arise from mechanical erosion or infection following aortic prosthetic surgery.

Observation:

• A 59-year-old male with a history of aortic-bi-femoral bypass presented with dyspepsia and biliary vomiting, mimicking an obstructive syndrome.
• Computed tomography revealed inflammatory tissue and air bubbles between the third duodenal segment and the aortic prosthesis.
• Surgical intervention involved detaching the prosthesis, performing a gastro-jejunal anastomosis due to intestinal dehiscence.

Findings:

• This case represents the first reported instance of a secondary ADF presenting primarily as a bowel obstructive syndrome.
• The incidence of secondary ADF as a complication of aortic surgery is estimated between 0.3% and 2%.
• Diagnosis can be challenging, particularly when the presentation is atypical, deviating from classic gastrointestinal bleeding.

Implications:

• Aorto-duodenal fistulae must be suspected in patients with a history of aortic prosthesis presenting with unexplained digestive bleeding or obstructive symptoms.
• Explorative laparotomy remains the gold standard for diagnosis and surgical management of ADF.
• Early recognition and surgical intervention are crucial for managing the mechanical bowel obstruction and preventing further complications.