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Case Reports
. 2022 Oct 11:9:975871.
doi: 10.3389/fcvm.2022.975871. eCollection 2022.

Case report: Remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair

Wen-Dong Li  1 , Guang-Yan Wu  1 , Bin Song  1 , Jie Zhao  1 , Xiao-Qiang Li  1 , Min Zhou  1
Affiliations
Case Reports

Case report: Remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair

Wen-Dong Li et al. Front Cardiovasc Med. .

Abstract

Aorto-duodenal fistula (ADF) is a rare cause of upper gastrointestinal bleeding, but it is associated with high mortality. It usually occurs in patients with prior aortic surgery or who have undergone aortic graft placement. Abdominal aortic aneurysm (AAA) might be a cause of primary ADF, which could develop into sudden shock. Because ADF is difficult to diagnose, surgery to correct it has a poor outcome. We here report the successful treatment of an ADF complicated with infected AAA after endovascular repair of a ruptured aneurysm of the iliac artery.

Keywords: aortic abdominal aneurysm; aorto-duodenal fistula; endovascular aortic repair complications; infected aneurysm; ruptured iliac artery aneurysm.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Images of CTA and endoscopy before treatments. (A) Endovascular repair and drainage had been performed when the patient was hospitalized. (B–D) A low-density shadow hinting at an abscess in the right psoas major muscle and around the stenting. (E) Fistulae in the horizontal part of duodenum found via endoscopy.
FIGURE 2
FIGURE 2
Images taken during the operation. (A) The stent in the abdominal artery was removed using an injector. (B,C) Pus and fistula were found surrounding the horizontal part of duodenum. (D) The infected abdominal aortic artery was replaced with a bovine pericardium biological mesh. There were many small masses around the abdomen. Pathological analysis showed this mass to be Schistosoma eggs. (E) A schematic diagram of the surgery in the horizontal part of duodenum.
FIGURE 3
FIGURE 3
CTA result at 1 month after the operation. Abscesses in the abdomen were cured. The bypass vessels and the lumen were unobstructed.
See this image and copyright information in PMC

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