Secondary aortoenteric fistula successfully treated with staged endovascular repair and duodenal resection without graft removal.

Secondary aorto-enteric fistulae (SAEF) are rare life-threatening complications that occur after abdominal aortic graft implant to treat aortic aneurysm or occlusive disease. Conventional treatments such as extra-anatomic bypass grafting with aortic ligation and subsequent graft removal with bowel repair are associated with a 25% to 90% operative mortality rate. In the emergency setting, patients unsuitable for major arterial surgery may benefit from a staged, less invasive approach. We present a case of SAEF treated with endoluminal deployment of a stent graft followed by duodenojejunal resection and anastomosis without further aortic reconstruction and graft removal.

Multifaceted surgical approach of combined thoracoretroperitoneal incision and midline abdominal incision for a secondary aortoenteric fistula.

BACKGROUND: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach. CASE PRESENTATION: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications. CONCLUSIONS: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.

Digestive hemorrhage and fever as a result of a double secondary aortoenteric fistula following the repair of a juxtarenal abdominal aortic aneurysm and an infection of the aortobifemoral bypass graft: a case report.

A double secondary aortoenteric fistula (AEF) occurs in a patient who has had significant aortic surgery and is characterized by a direct connection between the gastrointestinal (GI) tract and the aorta at two separate sites. Importance: During aortoc reconstructive surgery, the patient may present with a variety of unusual complaints, including fever and GI bleeding. These symptoms are indicative of problems, including the development of an aortoentric fistula, particularly when there is a double secondary fistula. Case presentation: The patient was admitted to the hospital due to hematemesis, melena, and high-grade fever after undergoing synthetic grafting aortobifemoral bypass (anatomical reconstruction) and partial resection of the juxtarenal abdominal aortic aneurysm. Pus discharge and a double aortoenteric fistula in unusual sites such as the second-third portion of the duodenum and caecum are visible in upper GI endoscopy and computed tomography angiography. The patient underwent a two-stage open surgery, the first stage involving aortic limb graft exclusion and extra anatomical reconstruction, and the second stage involving graft removal, fistula management, and bowel repair. Then the patient spent a few days in the surgical intensive care unit before being discharged. Clinical discussion: Primary and secondary AEF are the two categories of AEF. In patients who underwent aortic reconstruction surgery, the frequency of secondary AEF ranges from 0.36 to 1.6%. Due to the 8:1 injury ratio in the secondery AEF, men suffer more injuries than women.There are two types of fistula depending on whether or not the suture line is involved. The first form is graft enteric erosion, which excludes the suture line, while the second type is entric graft fistula, where the suture line is included. Most common site fistula is third and fourth part of duodenum and least common site is fistula formation in large bowel. Conclusions: An uncommon complication is double secondary AEF following aortic reconstruction surgery. Since one of the most significant presentations an AEF patient can present with is major GI bleeding and sepsis, A delay in seeking immediate medical treatment could result in the patient's death. It should be emphasized that one of the mechanisms for AEF formation and a frequent cause of sepsis in patients is recurrent aortic graft infection following aortic reconstruction surgery.

A case report of primary aortoduodenal fistula: A forgotten cause of gastrointestinal bleeding.

Aortoenteric fistula is one of the uncommon emergencies and is challenging to navigate for diagnostic testing. Here, we present a clinical case of an aortoduodenal fistula with primary etiology. A 73-year-old female patient with a history of hypertension was admitted to the hospital because of a 1-day history of melena. Ultrasound showed an abdominal aortic aneurysm sized (33 × 46) mm and a hematoma on the wall of the aorta. The patient underwent a gastrointestinal endoscopy with no bleeding point detected. However, the patient suddenly fell into a hemorrhagic shock on day 3 of admission. We rapidly performed fluid resuscitation, blood transfusion, a second gastrointestinal endoscopy, and a computed tomography scan of the abdomen with contrast injection that revealed a fistula from the abdominal aorta into the second segment of the duodenum. The patient was indicated for urgent endovascular aortic repair. Although this technique was successful with 3 abdominal aortic stents, the patient died due to multiorgan failure. Delayed diagnosis is the root cause of primary aortoduodenal fistula treatment failure, so it is important for clinicians to keep aortoduodenal fistula in mind as a possible cause of gastrointestinal bleeding in any patient.

A Case Series of Secondary Aortoenteric Fistula after Open Aortic Aneurysm Repair: Timing and Technique of Surgery.

Secondary aortoenteric fistula (sAEF) is a rare but serious complication after open aortic aneurysm repair (OAR). Although there is no consensus on the treatment strategy for sAEF, acute management of bleeding and infection control greatly affect the outcome. We report five cases of sAEF following OAR from 2016 to 2021. One patient died of sepsis following graft infection, whereas the others had relatively good outcomes. No recurrence of infection or fistula has been observed over an average follow-up period of 29.8 months. Timely management of bleeding and infection with surgical intervention resulted in favorable outcomes in our patients.

Life-saving case of cardiopulmonary arrest by secondary aortoenteric fistula formed in the anastomotic site between the inferior mesenteric artery and aortic graft.

Background: Secondary aortoenteric fistula is a fatal cause of gastrointestinal bleeding after aortic reconstructive surgery with a prosthesis. In most cases, the proximal suture line is involved. We herein report a rare case in which the fistula formed between the suture line of inferior mesenteric artery reimplantation and the jejunum. Case Presentation: An 82-year-old man was transferred to our hospital due to hematemesis with severe hypovolemic shock. Although he fell into cardiopulmonary arrest, immediate resuscitation achieved return of spontaneous circulation. As his surgical history of aortic reconstruction and computed tomography findings suggested potential secondary aortoenteric fistula, emergency surgery was carried out. The anastomosis between the inferior mesenteric artery and aortic graft was communicating with the jejunum. Partial jejunal resection was undertaken, and the aortic graft was replaced. Conclusion: The anastomosis between the inferior mesenteric artery and aortic graft in the previous aortic replacement can become the site of secondary aortoenteric fistula.

Surgical approach to recurrent secondary aortoenteric fistulas: A case report.

The increasing number of abdominal aortic grafts due to abdominal aortic aneurysms has caused secondary aortoenteric fistulas to be seen more frequently as a cause of gastrointestinal bleeding. High index of suspicion plays a significant role in the diagnosis in patients having clinical symptoms ranging from fecal occult blood to massive gastrointestinal bleeding, accompanied by hemorrhagic shock. A 65-year-old male patient developed two secondary aortoenteric fistulas consecutively. The first one was aortic graft-jejunal and the second one was aortic graft-duodenal in a short period. Secondary aortoenteric fistula developed after aortobifemoral bypass. The patient underwent graft revision and jejunal repair. He was reoperated three months later due to the newly developed aortic graft-duodenal fistula. The duodenal defect was closed, and an extra-anatomic aortoiliac bypass was performed to avoid graft-related enteric fistula. The patient was discharged uneventfully and was free from any complication at nine months after surgery.

A Case of an Aortoenteric Fistula Occurring 27 Years after Y Graft Replacement / 日本心臓血管外科学会雑誌

A 92 year-old-female with melena was admitted to our hospital. She underwent Y-graft replacement of the abdominal aorta at the age of 65. Gastroduodenal fiberscopic examination and computed tomography (CT) confirmed the diagnosis of aortoduodenal fistula. The fistula in the proximal anastomotic site was occluded with a suture ligature and omentopexy was performed. On the 15th post-operative day she developed high-grade fever. CT revealed a pseudoaneurysm formation at the proximal anastomosis site. She underwent emergency endovascular aneurysmal repair (EVAR). Her postoperative course was uneventful. She is doing well without symptoms of recurrent infection.

Endovascular Aneurysmal Repair for an Aortoenteric Fistula / 日本心臓血管外科学会雑誌

We report a case of secondary aortoenteric fistula (SAEF). A 76-year-old man who had undergone bifurcated graft replacement for an abdominal aortic aneurysm 18 years previously was admitted to our hospital on 2008. Since the patient was in hemorrhagic shock and had several comorbidities, he first underwent emergency endovascular aneurysmal repair (EVAR). The patient recovered from shock, and then the duodenal fistula was closed and a temporary tube enterostomy was made on the next day. The patient's recovery was uneventful and he was discharged 34 days after EVAR without any sign of infection. However, the patient was admitted for a recurrent SAEF 16 months after the procedure. Although emergency surgery was performed, he died due to sepsis 11 days after surgery. EVAR could be useful to control bleeding associated with SAEF ; however, it would be necessary for a long-term results to perform additional radical surgery subsequently to ensure the patients' hemodynamic recovery.