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Case Reports
. 2018 Mar;22(1):40-42.
doi: 10.4235/agmr.2018.22.1.40. Epub 2018 Mar 31.

Asymptomatic Secondary Aortoduodenal Fistula Incidentally Diagnosed During a Health Check-up: A Case Report

Sang Ki Park  1 , In Chul Min  2 , Sung Hoon Lee  1 , Jae Ik Lee  1 , Ji Min Kim  3 , Kyong Hye Joung  3 , Bon Jeong Ku  3
Affiliations
Case Reports

Asymptomatic Secondary Aortoduodenal Fistula Incidentally Diagnosed During a Health Check-up: A Case Report

Sang Ki Park et al. Ann Geriatr Med Res. 2018 Mar.

Abstract

Secondary aortoenteric fistulas (AEFs) are an uncommon but fatal complication of abdominal aortic reconstructive surgery. Aortoduodenal fistulas (ADFs) are the most frequent secondary AEFs (80%). The incidence of secondary AEFs is increasing because of the increasing number of individuals undergoing aortic aneurysm repairs with prosthetics. In most cases of secondary AEFs, surgical repair is performed with the patient in a poor condition, owing to late diagnosis. Thus, an early diagnosis is crucial. We report a case of an asymptomatic secondary ADF that was incidentally diagnosed using esophagogastroduodenoscopy (EGD) and computed tomography during a health check-up and was successfully repaired, with the patient in a stable condition even after the development of life-threatening symptoms. Based on our case, we suggest that noticing unexplained leukocytosis in regular hematological examination and performing surveillance EGD in an asymptomatic individual who has undergone abdominal aortic reconstructive surgery may aid in the early diagnosis of secondary AEFs before fatal complications manifest.

Keywords: Aorta; Asymptomatic Disease; Duodenum; Fistula.

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Conflict of interest statement

Conflicts of Interest Disclosures The researchers claim no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
(A) Preoperative endoscopic image shows prosthesis perforating the third portion of duodenum without bleeding and obstruction sign (arrow). (B) Postoperative endoscopic image does not show the aortic prosthesis that was previously observed in the third portion of the duodenum.
Fig. 2.
Fig. 2.
Computed tomography images show the prosthesis penetrating the third portion of the duodenum(A, arrow) and ectopic gas adjacent to the aortic prosthesis (B, arrowhead).
See this image and copyright information in PMC

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