Aortoduodenal fistula following aortobifemoral bypass.

A patient with a fistula between the aortic graft and the third portion of the duodenum was admitted in our institution and submitted to surgery that involved extra anatomical axillobifemoral bypass, prosthesis removal and bowel resection with a gastrojejunal Roux anastomosis. A prosthetic fistula after aortic surgery is a rare but potentially fatal complication. Erosion, infection and pseudoaneurysm are mechanisms in the pathogenesis of aortoenteric fistula. Because of the high mortality and morbidity, associated with secondary aortoenteric fistula, surgical treatment is always recommended. A combination of endoscopy and CT or MRI may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion. An aortoenteric fistula should always be suspected in all patients who have undergone aortic graft surgery and present with gastrointestinal haemorrhage. The authors discuss the modern management of this challenging complication of aortic surgery.