[Aorto-duodenal fistula--direct suture and pedicled omentum flap-plasty]

Between 1985 and 1993, six patients underwent emergency operation at the Department of General Surgery, Essen University Hospitals, for a secondary aorto-duodenal fistula. In all patients, a Dacron tube- or bifurcation prosthesis has been implanted 1-10 years previously to repair an arteriosclerotic aneurysm of the abdominal aorta. The main symptom of the aorto-duodenal fistula was massive gastrointestinal hemorrhage, with manifest shock in two cases. The most reliable diagnostic procedure, in addition to ultrasonography, was found to be computed angio-tomography. In three cases where there was erosion around the proximal aorto-prosthetic anastomosis, bacterial contamination was found during surgery. Direct reconstruction and pedunculated omentum plasty appear to be a safe method for closing an aorto-duodenal fistula. No patient died in the immediate postoperative period after direct reconstruction. One patient, however, died three months after surgery of myocardial infarction. Two patients suffered from fistula recurrence 1.25 and 3 years respectively after operation and died as a result. One patient died of the sequelae of a chronic obstructive pulmonary disease 3.5 years after the operation. The remaining two patients are still alive and free of complications more than 4 years after operation. Direct reconstruction and pedunculated omentum plasty appear to be a safe method for closing an aorto-duodenal fistula.