Surgical Treatment of Primary Aortoduodenal Fistula

Taheri, Syde A.; Kulaylat, Mahmoud N.; Grippi, John; Ricotta, John J.; Kale, Jayant R.; Bernhard, Harold

doi:10.1007/bf02329384

Cited by 26 publications

(11 citation statements)

References 36 publications

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“…Findings suggestive of ADF on upper gastrointestinal barium studies include persistent filling defects, a fleck of barium at the fistula site, a localized collection of barium, or an ulcer in the third portion of the duodenum. The occurrence of these findings in the presence of an abdominal aortic aneurysm should raise the suspicion of an ADF [29]. Barium studies may be more useful in the diagnosis of secondary ADF than of primary ADF.…”

Section: Discussionmentioning

confidence: 93%

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis

2000

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We report on the utility of computed tomography (CT) in making the diagnosis of primary aortoduodenal fistulas in two cases presenting with massive gastrointestinal hemorrhage. In both cases, the clinical presentation was insidious, no pulsatile abdominal mass was palpated, and endoscopy findings were inconclusive. CT showed minimally aneurysmal aortas communicating with larger areas of contained rupture and pseudoaneurysm stretching adjacent small bowel.

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Section: Discussionmentioning

confidence: 93%

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis

2000

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“…Primary or spontaneous aortoenteric fistulae are rare, with their incidence has been reported at 0.04% to 0.07% in autopsy series (6). The incidence of fistulae as a complication of aortic aneurysms is 0.1% to 0.8% (7).…”

Section: Discussionmentioning

confidence: 99%

Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient

et al. 2004

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Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.

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“…In großen Autopsiestudien wird eine Inzidenz zwischen 0,04-0,07% aller Gastrointestinalblutungen angegeben [15,18] [1,20]. Die Bedeutung einer subklinischen lokalen Infektion in der Genese primä-rer aortoenteraler Fisteln ist dabei noch nicht vollständig geklärt [36]; ein Zusammenhang wird jedoch in der Mehrzahl der veröffentlichten Fallberichte primärer Fisteln nach Radiatio angenommen [8,21,37,38] tere wichtige pathogenetische Faktoren [8,35,36]. Obwohl Dünndarmepithel deutlich strahlensensibler ist, werden auch große und kleinere Arterien durch ionisierende Strahlung geschädigt.…”

Section: Inzidenz Lokalisationunclassified

“…Liegt ein arteriosklerotisches Bauchaortenaneurysma der Fistel zugrunde, wird gelegentlich eine Symptomtrias aus abdominellen Schmerzen, pulsierendem abdominellen Tumor und gastrointestinaler Blutung gefunden [35]. Gewöhnlich imponiert eine aortoenterale Fistel nur als gastrointestinale Blutung [36].…”

Section: Klinikunclassified

“…Die Blutung limitiert sich vermutlich durch Spasmen der Darmwand auf die plötzliche Dehnung selbst. Auch die arterielle Hypotension im Rahmen einer aktiven Blutung und bereits vorbestehende Thromben im Bereich der aortalen Gefäßwand tragen möglicherweise zum Sistieren der Blutung durch Stase und schließlich thrombotischen Verschluss der Fistel bei [12,19,35]. In der Mehrzahl der Fälle setzt nach einem blutungsfreien Intervall von 6-24 Stunden eine oft letal verlaufende erneute Blutungsepisode ein [27].…”

Section: Klinikunclassified

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Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

Drognitz

Pfeiffenberger

Schareck

et al. 2002

Chirurg

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Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

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Surgical Treatment of Primary Aortoduodenal Fistula

Cited by 26 publications

References 36 publications

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis

Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient

Primäre aortoduodenale Fistel als Spätkomplikation nach paraaortaler Radiatio Ein Fallbericht

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