PMC4189064_01
Preoperative CT angiogram showing a 5.8 cm inflammatory abdominal aortic aneurysm.
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A 75 year-old male patient, who underwent endovascular repair of a 5.8 cm inflammatory abdominal aortic aneurysm two and a half years previously (Fig. 1), was transferred from another centre complaining of acute abdominal pain and haematemesis of one day duration.
CT angiogram of the aorta showing multiple bubbles of gas within the aneurysm sac surrounding the stent graft.
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A computerized tomography angiogram of the aorta showed multiple bubbles of gas within the aneurysm sac surrounding the stent graft (Fig. 2) with no discernible wall separating the aneurysm sac from the lumen of the distal third part of the duodenum, along with a psoas abscess measuring 6 x 4 cm.
Operative view of the duodenal defect.
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Consequently, surgical exposure of the duodenal defect was done (Fig. 3), after which dissection of the abdominal aorta and identification of the fistula (Fig. 4) was achieved.
Ex-vivo image of the endograft.
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This was followed by surgical excision of the infected endograft (Fig. 5) with suturing of the proximal infrarenal aortic stump and distal iliac ends.