A Case of Secondary Aortoduodenal Fistula, 6 Years after Abdominal Aortic Surgery

Masahiro Ohira, Yoshio Miura, Midori Sasaki, Tsuyoshi Yamaguchi, Hideto Sakimoto, Kei Koide, Takaaki Etou and Makoto Takahashi

Department of Surgery, Chugoku Rosai Hospital

An 80-year-old man, who had undergone a graft replacement for an abdominal aortic aneurysm 6 years ago, was admitted for repeated intermittent gastrointestinal bleeding of unknown origin. Upper and lower fiberoptic examinations, CT, and angiography failed to detect the bleeding site. ^99mTc scintigraphy showed an uptake in the left upper quadrant. With no definite diagnosis, the patient underwent emergency surgery due to massive bleeding. An aortoduodenal fistula (ADF) was found. and excised, followed by simple closure of the duodenum and aorta. On postoperative day (POD) 14, he again suffered gastrointestinal bleeding. Endoscopy showed multiple bleeding ulcers in the third portion of the duodenum. Despite endoscopic procedures such as clipping and local injection of ethanol, he had a massive hemorrhage on POD 21. Reoperation showed bleeding from ulcers and a recurrent ADF. Due to his poor general condition, he underwent suture ligation of the ulcers and ADF inside the duodenum. He died of multiple organ failure four days later. Autopsy found a giant hematoma between the duodenum and aorta that was a result of recurrent ADF and may have caused ischemic change in the duodenum resulting in multiple ulcers. ADF is a rare but lethal complication of aortic reconstructive surgery that vascular and gastroenterological surgeons must bear in mind as a possible cause of gastrointestinal bleeding.

Key words
aortoduodenal fistula, aortoenteric fistula, complication after abdominal aortic surgery

Reprint requests
Masahiro Ohira Department of Surgery, Chugoku Rosai Hospital
1-5-1 Hirotagaya, Kure, 737-0193 JAPAN

Accepted
September 24, 2003

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