SECONDARY AORTODUODENAL FISTULA: AORTOBIFEMURAL BY-PASS COMPLICATED WITH INFECTION AND GASTROINTESTINAL BLEEDING – A SURGICAL EMERGENCY

Abstract

Aortoduodenal fistula is a fatal condition that involves a pathological connection between the aorta and the duodenum. Secondary aortoduodenal fistulas are a complication of aortic surgery. The presentation symptoms include upper gastrointestinal bleeding (most common), unexplained fever, pulsatile abdominal mass, bowel obstruction and abdominal pain. A 69-year-old patient known with systemic mastocytosis JAK2 positive myeloproliferative neoplasm as well as aortoiliac occlusive disease, for which in 2018 it was performed an aortobifemoral Dacron graft bypass, followed by multiple complications, presented at our hospital for melena. During the upper gastrointestinal endoscopy, it was revealed that the vascular graft had penetrated the third part of the duodenum, causing active bleeding. The patient was transferred immediately to the cardiovascular surgery department. Emergency surgical intervention was performed by a multidisciplinary team (cardiovascular surgeon, general surgeon), the procedure consisted of complete excision of the aortobifemoral Dacron graft, aortofemoral suture and transverse duodenorrhaphy; 24 hours after surgery septic shock, as well as multiple organ system dysfunction syndrome occurred, and the patient died. Diagnosis should be established immediately and then the principles of treatment must be applied promptly and should be taken into account for all patients with a history of cardiovascular abdominal surgery. Even if the treatment is applied correctly, it is associated with multiple complications and an increased risk of perioperative death.