Primitive aorto-duodenal fistula – A propos a successfully treated case at Viet Duc hospital and review the literature

Abstract

Introduction: Primary aorto-enteric fistula (PAEF) is a rare disease in which a direct communication between the aorta and gastrointestinal structure occurs and causes a gastrointestinal bleeding with high mortality - 100% if untreated in emergency. Method: Retrospective descriptive report of a rare clinical case of aorto-duodenal fistula which was successfully treated at Viet Duc University Hospital, and a review of the literature on this pathology. Result: Case report - a 40-year-old male patient was hospitalized with hemorrhagic shock, abdominal pain, continuous melaena, computed tomography without contrast showed images of abdominal aortic aneurysm 7cm of diameter just below the bifurcation of the renal artery, communicating with the gastrointestinal structure. Surgical treatment was oversewing above and below the aneurysm, extra-anatomical bypass with vascular prothesis; resection of D3, D4 duodenum, duodenum-jejunostomy, jejunostomy. He was discharged from hospital after 26 days, re-examinated 3 months after surgery. The literature in the world reports less than 500 cases of this disease, there are many causes with the most common anatomical locations being fistulas in the duodenum and esophagus. Conclusion: PAEF is a serious disease that requires early diagnosis and multi-specialty emergency management, computed tomography has a high value in definitive diagnosis. Treatment by abdominal aortic oversewing, extra-anatomical bypass and intestinal resection have quite high success rates.