Primary Aortoduodenal Fistula: First you Should Suspect it

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 31; no. 3; pp. 261 - 263
• Main Authors: Beuran, Mircea, Negoi, Ionut, Negoi, Ruxandra Irina, Hostiuc, Sorin, Paun, Sorin
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01.01.2016
• Subjects: Aorta, Abdominal; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiology; Digestive System Fistula; Duodenal Diseases - diagnostic imaging; Duodenal Diseases - surgery; Duodenum; Gastrointestinal diseases; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - surgery; Gastrointestinal surgery; Heart surgery; Hemorrhage; How to Do It; Humans; Intestinal Fistula - diagnostic imaging; Intestinal Fistula - surgery; Male; Middle Aged; SURGERY; Tomography; Tomography, X-Ray Computed; Vascular Fistula - diagnostic imaging; Vascular Fistula - surgery; Duodenum; Aorta, Abdominal; Digestive System Fistula
• ISSN: 0102-7638; 1678-9741; 1678-9741
• DOI: 10.5935/1678-9741.20160049

A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition. The postoperative recovery was uneventful, with discharge after 12 days.