Endovascular repair of a presumed aortoenteric fistula: late failure due to recurrent infection.
OBJECTIVE
To describe a case of presumed aortoduodenal fistula that was treated by endovascular implantation of a stent-graft.


RESULTS
A 76-year-old man was transferred from another hospital where he had been treated for upper gastrointestinal hemorrhage over a 2-month period. Ten years previously, he had undergone aortobifemoral bypass, the right limb of which recently thrombosed. At the time of transfer, computed tomographic scanning showed a large false aneurysm between the aorta and the duodenum. Endoscopy disclosed mucosal erosions in the fourth portion of the duodenum. Following implantation of 2 overlapping stent-grafts, the bleeding ceased and the false aneurysm disappeared. At no time did the patient have a fever. The patient initially did well, but 8 months after treatment, he presented with fever and chills. Recurrent infection had caused erosion of the aorta so that a large portion of the stent-graft was visible from the duodenum. The infected graft and stent-grafts were removed in a two-part operation, from which the patient recovered satisfactorily.


CONCLUSIONS
Endovascular stent-grafts may have a role to play in the management of aortoduodenal fistula, if only as a temporary measure to control bleeding.
Chuter
T A
TA
Department of Surgery, University of California, San Francisco 94143, USA. chutert@surgery.ucsf.edu
Lukaszewicz
G C
GC
Reilly
L M
LM
Kerlan
R K
RK
Faruqi
R
R
Sawhney
R
R
Wall
S D
SD
Canto
C
C
LaBerge
J M
JM
Gordon
R L
RL
Messina
L M
LM
D000368:Aged; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004384:Duodenoscopy; D004386:Duodenum; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D012086:Reoperation; D013530:Surgical Wound Infection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*