title: An aortoduodenal fistula as a complication of immunoglobulin G4-related disease.
abstract: Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair.
authors.affiliation: Clinic for Vascular and Endovascular Surgery, Military Medical Academy, 11000 Belgrade, Serbia.
authors.forename: Momir
authors.initials: M
authors.lastname: Sarac
authors.forename: Ivan
authors.initials: I
authors.lastname: Marjanovic
authors.forename: Mihailo
authors.initials: M
authors.lastname: Bezmarevic
authors.forename: Uros
authors.initials: U
authors.lastname: Zoranovic
authors.forename: Stanko
authors.initials: S
authors.lastname: Petrovic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Mihajlovic
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery; D001018:Aortic Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D004378:Duodenal Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery; D057510:Endovascular Procedures; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007412:Intestinal Fistula / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D007074:Immunoglobulin G; D013256:Steroids