Abdominal aortic aneurysm causing duodenal obstruction: Two case reports and review of the literature

Abstract

Obstruction of the upper gastrointestinal tract caused by an abdominal aortic aneurysm (aortoduodenal syndrome) has been rarely reported. The typical presentation includes protracted emesis in a patient with a pulsatile abdominal mass. Clinical features of weight loss, abdominal pain, and distention are present less frequently. The diagnosis is suggested by findings on computed tomography scans, and may be confirmed with upper gastrointestinal contrast material-enhanced studies or upper endoscopy. Aortic aneurysmorrhaphy is curative, and should be undertaken after gastrointestinal decompression and correction of fluid and electrolyte disturbances. We report 2 cases of abdominal aortic aneurysm producing upper gastrointestinal obstruction, and provide a review of the literature relevant to this clinical syndrome.

Aortoduodenal syndrome in a patient receiving maintenance haemodialysis

“…The patient's postoperative course had an unfavourable short-term outcome; despite improvement in his emesis he had persistent anorexia, necessitating the continuous administration of intravenous fluids. Previous reports have found a high failure rate of gastrointestinal bypass for duodenal obstruction caused by AAA 2. Although the surgical risk was deemed too high in our patient, he might have benefited from direct AAA repair, as this has been shown to result in good outcomes 2–4.…”

Enlarging Abdominal Aortic Aneurysm Causing Complete Obstruction of the Duodenum

“…Duodenal obstruction is a rare presenting complication of abdominal aortic aneurysm [1] . It is usually due to compression of the third part of the duodenum by the abdominal aortic aneurysm itself or, less commonly, between the neck of the aneurysm and superior mesenteric artery [2] .…”

Endovascular treatment of a Superior Mesenteric Artery Syndrome variant secondary to traumatic pseudoaneurysm

“…In its commonest form it is not associated with an acquired structural abnormality: the angle between the SMA and aorta is constitutionally narrowed. In its best-known acquired variant, the aortoduodenal syndrome, the duodenum is compressed between the SMA and an abdominal aortic aneurysm [10]. This case is unique, comprising both the first description of a variant of SMA syndrome caused by a traumatic SMA pseudoaneurysm and the first account of successful treatment of both the aneurysm and duodenal obstruction by endovascular stent placement.…”