title: Aortoduodenal fistula three years after aortobifemoral bypass: case report and literature review.
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.
authors.affiliation: Department of Surgery, University Clinical Center Maribor, Maribor, Slovenia. ursusmarolt@gmail.com
authors.forename: Urska
authors.initials: U
authors.lastname: Marolt
authors.affiliation: Department of Surgery, University Clinical Center Maribor, Maribor, Slovenia.
authors.forename: Stojan
authors.initials: S
authors.lastname: Potrc
authors.affiliation: Department of Vascular Surgery, University Clinical Center Maribor, Maribor, Slovenia.
authors.forename: Andrej
authors.initials: A
authors.lastname: Bergauer
authors.affiliation: Department of Surgery, University Clinical Center Maribor, Maribor, Slovenia.
authors.forename: Nuhi
authors.initials: N
authors.lastname: Arslani
authors.affiliation: Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia.
authors.forename: Dino
authors.initials: D
authors.lastname: Papes
mesh_terms: D001018:Aortic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005263:Femoral Artery / Q000637:transplantation; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy