Acta clinica Croatica, Vol. 52. No. 3., 2013.
Other
Aortoduodenal Fistula Three Years after Aortobifemoral Bypass: Case Report and Literature Review
Urška Marolt
Stojan Potrč
Andrej Bergauer
Nuhi Arslani
Dino Papeš
Abstract
Secondary aortoenteric fistulas (SAEF ) are a relatively rare but dangerous complication of aortal reconstructive surgery. We present a patient that underwent aortobifemoral bypass three years before developing the signs of aortoenteric fistula, and we reviewed the literature on the topic. Since the clinical signs are nonspecific, physicians should have a high index of suspicion for SAEF in patients who underwent aortal reconstructive surgery. The most useful diagnostic tools for stable patients are upper gastrointestinal endoscopy and computed tomography scan with contrast that can, in combination with history and clinical signs, enable accurate diagnosis in more than 90% of patients. Unstable patients with suspected aortoenteric fistula should undergo exploratory laparotomy. The treatment of choice is open surgery with graft excision, wide debridement of infected tissue, bowel repair or resection followed by an extra-anatomic bypass or in situ placement of a new graft. Early postoperative mortality remains high, around 30% in most analyses. Currently there are no guidelines for the diagnosis and management of SAEF , so individualized approach is necessary for each patient.
Keywords
Aortoenteric fistula; Upper gastrointestinal bleeding; Postoperative complications; Aortobifemoral bypass; Endovascular procedures
Hrčak ID:
116854
URI
Publication date:
1.9.2013.
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