Primary aortoduodenal fistula: successful grafting with axillo-bifemoral bypass

Abstract

Primary aortoduodenal fistula (PADF) is uncommon direct pathological communication between the abdominal aorta and duodenum, which may cause life-threatening gastrointestinal bleeding. PADF leads to high mortality and morbidity unless it is promptly evaluated and appropriate surgical intervention performed. We present a case report describing PADF treated successfully with axillobifemoral bypass. A 70-year-old male was admitted in our hospital with severe back and abdominal pain. A pulsative tumor mass was palpated in the middle abdomen. Previous ultrasonography had shown abdominal aortic aneurysm. There were no symptoms of active gastrointestinal bleeding, but the patient had moderate anaemia. Computer tomography revealed infrarenal abdominal aortic aneurysm. Intraoperatively, PADF was diagnosed. The duodenum was repaired and the abdominal aorta was closed directly below the renal arteries. At the next stage, extra-anatomic grafting was performed, because frank pus was found in the abdominal cavity. By present time, the axillobifemoral bypass has been patent for 2 years.