Vol 5, No 2 (2003)
Published online: 2003-05-26
The surgical treatment of aorto-duodenal fistulas after reconstructive operations of the abdominal aorta
Chirurgia Polska 2003;5(2):83-90.
Abstract
Background: In this paper the methods used in surgical treatment of secondary aorto-intestinal fistulas are presented.
Material and methods: 10 cases of patients treated for secondary aorto-intestinal fistulas as a complication of vascular prosthesis implantation are analysed. The patients underwent the operation of infected dacron prosthesis’ replacement with arterial homograft, silver-coated prosthesis or extra-anatomic bypass (subclavian to femoral). To close the intestinal fistula, a duodenectomy with gastroenterostomy was performed or the duodenum was sutured and protected with the use of the pedicled omentum.
Results: A hemorrhage from the upper intestinal tract after the reconstructive surgery of the abdominal aorta with the use of a vascular prosthesis was the main symptom of the presence of a fistula. The abdominal CT revealed a false aneurysm of the upper anastomosis and the inflammatory infiltration in this region. A scintigraphy examination revealed infection of the vascular prosthetic in all patients. In all cases, the fistula was located in the horizontal part of the duodenum. A duodenectomy was performed on 4 patients. In the other 6 patients the duodenal fistula was closed with two layers of stitches and the greater omentum was sewn on duodenum for protection. The presence of the fistula was the result of the rupture of the upper anastomosis between aorta and the prosthetic graft in 8 cases and the prosthesis’ decubitus in 2 cases. 4 patients died in the follow-up period - in 3 cases the reason was an unhealed duodenal fistula that resulted in peritonitis.
Conclusions: A secondary aorto-duodenal fistula is the most serious complication of the vascular graft infection. The treatment of a fistula is a difficult and hazardous surgical procedure, the results of which are unpredictable.
Material and methods: 10 cases of patients treated for secondary aorto-intestinal fistulas as a complication of vascular prosthesis implantation are analysed. The patients underwent the operation of infected dacron prosthesis’ replacement with arterial homograft, silver-coated prosthesis or extra-anatomic bypass (subclavian to femoral). To close the intestinal fistula, a duodenectomy with gastroenterostomy was performed or the duodenum was sutured and protected with the use of the pedicled omentum.
Results: A hemorrhage from the upper intestinal tract after the reconstructive surgery of the abdominal aorta with the use of a vascular prosthesis was the main symptom of the presence of a fistula. The abdominal CT revealed a false aneurysm of the upper anastomosis and the inflammatory infiltration in this region. A scintigraphy examination revealed infection of the vascular prosthetic in all patients. In all cases, the fistula was located in the horizontal part of the duodenum. A duodenectomy was performed on 4 patients. In the other 6 patients the duodenal fistula was closed with two layers of stitches and the greater omentum was sewn on duodenum for protection. The presence of the fistula was the result of the rupture of the upper anastomosis between aorta and the prosthetic graft in 8 cases and the prosthesis’ decubitus in 2 cases. 4 patients died in the follow-up period - in 3 cases the reason was an unhealed duodenal fistula that resulted in peritonitis.
Conclusions: A secondary aorto-duodenal fistula is the most serious complication of the vascular graft infection. The treatment of a fistula is a difficult and hazardous surgical procedure, the results of which are unpredictable.
Keywords: secondary aorto-duodenal fistulavascular graft infectionarterial homograftsilver-coated prosthesis
