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Aorto-duodenal fistula secondary to aortic graft replacement

Morgan Vandermeulen1,2, Dorian Verscheure3, Laurent Genser1,4

  • 1Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Paris, France.

Acta Chirurgica Belgica
|December 21, 2021
PubMed

Insights

Secondary aorto-duodenal fistula (SADF), a complication of aortic prosthesis infection, presents varied symptoms. Early surgical intervention and multidisciplinary care are crucial for managing this rare but serious condition, improving patient outcomes.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Radiology

Background:

  • Secondary aorto-duodenal fistula (SADF) is a rare but severe complication of aortic prosthesis infection, with reported incidence up to 45% of cases.
  • Clinical presentations of SADF are diverse, ranging from subtle graft infection signs like fever to life-threatening massive gastrointestinal bleeding.

Purpose of the Study:

  • To highlight indirect computed tomography (CT) scan signs indicative of SADF.
  • To emphasize the importance of timely surgical management for SADF based on CT findings.
  • To illustrate intraoperative diagnosis of the fistula.

Main Methods:

  • Review of clinical cases and associated CT scans of patients diagnosed with SADF.
  • Correlation of indirect CT findings with confirmed fistula diagnosis.
  • Documentation of surgical findings and outcomes.

Main Results:

  • CT scans can reveal indirect signs that should alert clinicians to the possibility of SADF.
  • Emergency surgery, despite high initial morbidity and mortality, is essential for diagnosis and treatment.
  • Multidisciplinary management leads to favorable midterm outcomes in surviving patients.

Conclusions:

  • Prompt surgical intervention guided by CT scan interpretation is critical for managing SADF.
  • Early recognition of indirect CT signs can facilitate timely diagnosis and treatment.
  • Multidisciplinary approaches improve outcomes for patients with SADF.
Keywords:
Fistulaaortaduodenumgraftprosthesis

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