title: Primary aorto-duodenal fistula secondary to infected abdominal aortic aneurysms: the role of local debridement and extra-anatomic bypass.
abstract: Gastrointestinal bleeding secondary to spontaneous rupture of an infected abdominal aortic aneurysm into the duodenum is a rare and highly lethal clinical occurrence, representing roughly a third of all primary aortoduodenal fistulas. Diagnosis is problematic due to the subtleties in the clinical presentation and course, and surgical treatment is usually delayed, representing a challenge even for the experienced vascular surgeon. The overall mortality is over 30% and the operative approaches are still controversial. Two cases of ruptured infrarenal aortic aneurysms complicated with aortoduodenal fistula were recently treated at our institution. Bacterial aortitis was documented by arterial wall cultures positive for Klebsiella and Salmonella species respectively. The clinical courses and outcomes of the two patients (one survivor ) treated with retroperitoneal debridement and extra-anatomic bypass and a review of the modern surgical treatment are herein described.
authors.affiliation: Hospital of Saint Raphael, Department of Surgery, New Haven, Connecticut, USA.
authors.forename: S
authors.initials: S
authors.lastname: Pagni
authors.forename: R W
authors.initials: RW
authors.lastname: Denatale
authors.forename: T
authors.initials: T
authors.lastname: Sweeney
authors.forename: C
authors.initials: C
authors.lastname: McLaughlin
authors.forename: A M
authors.initials: AM
authors.lastname: Ferneini
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001019:Aortic Rupture / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D003646:Debridement; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery