PMC5667283_01
Computed tomography images of a 69-year-old man with aortoduodenal fistula, taken on arrival at our hospital. A, A large hematoma was found in the stomach and duodenum (white arrows). A saccular aneurysm was connected to the duodenum by the hematoma (white circle). B, Anatomical computed tomography findings. Blue, green, and red lines represent the outlines of the stomach, duodenum, and aneurysm, respectively. Dotted line indicates the unclear boundary between the duodenum and aneurysm.
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Enhanced computed tomography (CT) showed a 50 x 52 x 53-mm infrarenal AAA that was saccular and connected to the duodenum by a hematoma (Fig. 1A, B). The hematoma was also present in the stomach and duodenum (Fig. 1A, white arrows).
Intraoperative findings in a 69-year-old man with aortoduodenal fistula and a history of alcoholism, malnutrition, and distal gastrectomy and Billroth I reconstruction. A, Angiography showed a saccular aneurysm. B, After endovascular aneurysm repair, the aneurysm disappeared and no extravasation or endoleaks remained. C, The transverse mesocolon and duodenum densely adhered to the abdominal aortic aneurysm by fibrous tissue. The aneurysm was covered by the mesocolon.
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AZ, USA) was successfully deployed in the infrarenal aorta. Angiography showed no extravasation or endoleak, and the bleeding was controlled (Fig. 2A, B). The transverse mesocolon and duodenum were densely and broadly adhered to the AAA with fibrous tissue (Fig. 2C).
Schematic representation of the operative findings and our procedures in a 69-year-old man with aortoduodenal fistula who underwent endovascular aneurysm repair. A, Abdominal aortic aneurysm and the duodenum were densely and broadly adhered to each other. The fistula was suspected to exist on the third portion of the duodenum (*). Following endovascular aneurysm repair, two tubes were inserted in the oral and anal sides of the jejunum for intestinal tract decompression. B, Postoperative computed tomography image at 7 days showed no endoleak or free air around the stent graft.
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Two tubes, 12- and 10-Fr, were inserted into the oral and anal sides of the jejunum, respectively (Fig. 3A). In addition, CT on postoperative day 7 showed no endoleak, extravasation, or abdominal abscesses (Fig. 3B).