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Secondary aortoduodenal fistulae

E Bastounis1, E Papalambros, V Mermingas

  • 1First Department of Surgery, Medical School, University of Athens, Laikon Hospital, Greece.

The Journal of Cardiovascular Surgery
|November 14, 1997
PubMed

Insights

Secondary aortoenteric fistula (SAF) is a rare, fatal complication after aortic surgery. Early diagnosis and surgical intervention, including graft removal and repair, are crucial for survival, though mortality remains high.

Area of Science:

  • Vascular Surgery
  • Gastrointestinal Surgery

Background:

  • Secondary aortoenteric fistula (SAF) is a rare but life-threatening complication following reconstructive aortoiliac surgery.
  • Diagnosis and management of SAF present significant clinical challenges.

Purpose of the Study:

  • To present a series of secondary aortoduodenal fistula cases.
  • To discuss the clinical presentation, treatment, and outcomes of SAF.

Main Methods:

  • Retrospective review of nine cases of secondary aortoduodenal fistulae between 1980 and 1992.
  • Description of surgical management, including graft removal, duodenal repair, and revascularization strategies.

Main Results:

  • The primary symptom was upper gastrointestinal bleeding, with a mean interval of 32 months post-aortic surgery.
  • Surgical management involved graft explantation and duodenal closure; some patients required revascularization.
  • Postoperative mortality was 33% (3 out of 9 patients).

Conclusions:

  • Upper gastrointestinal bleeding in patients with prior abdominal vascular surgery warrants high suspicion for SAF.
  • Exploratory laparotomy is essential to confirm or exclude SAF.
  • Prompt diagnosis and aggressive surgical management are critical, but outcomes remain guarded.

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