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Primary Aortoduodenal Fistula-A Case Report and a Review of the Literature
Mercy Varghese1, Geir Torvik Jorgensen1, Camilla Aune2
1Vascular Surgery Unit, Department of Surgery, Nordland Hospital, Bodo, Norway.
Abstract:
Primary aortoduodenal fistula (PADF) is a direct communication between the abdominal aortic aneurysm (AAA) and duodenum. It is a rare entity and causes life-threatening gastrointestinal hemorrhage. Diagnosis requires a high index of clinical suspicion, and surgery offers the only hope for survival. We present a 73-year-old male who was initially admitted to the hospital with back pain and fever. He was diagnosed with pyelonephritis and treated with antibiotics. Computed tomography of the abdomen showed an AAA, but no aortoduodenal fistula was seen. Twelve days later, he was admitted to the hospital as he was hemodynamically unstable. An emergency laparotomy revealed a PADF which was repaired. The aortic aneurysm was repaired with an in situ silver graft and a bifemoral bypass. However, the patient developed severe graft infection and later succumbed.
Insights
Primary aortoduodenal fistula (PADF) is a rare cause of life-threatening bleeding. This case highlights diagnostic challenges and the critical need for prompt surgical intervention in suspected PADF, despite potential complications.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Medical Diagnostics
Background:
- Primary aortoduodenal fistula (PADF) is a rare but life-threatening condition involving direct communication between an abdominal aortic aneurysm (AAA) and the duodenum.
- It often presents with severe gastrointestinal hemorrhage, necessitating a high index of clinical suspicion for timely diagnosis and management.
Observation:
- A 73-year-old male presented with back pain and fever, initially diagnosed with pyelonephritis.
- Abdominal CT revealed an AAA but did not identify a fistula. Twelve days later, the patient became hemodynamically unstable.
Findings:
- An emergency laparotomy confirmed a PADF, which was surgically repaired.
- The AAA was managed with an in situ silver graft and bifemoral bypass.
- The patient subsequently developed a severe graft infection, leading to a fatal outcome.
Implications:
- This case underscores the diagnostic difficulties associated with PADF, especially when initial imaging is inconclusive.
- Prompt surgical repair is crucial for survival, but the risk of complications such as graft infection remains significant.
- Further research into improved diagnostic modalities and infection prevention strategies for PADF is warranted.
