Aorto-duodenal Fistula

Ashley Davidoff MD

Aorto-duodenal fistula is a pathological connection between the aorta and the transverse portion of the duodenum.

Statistics

Aortoduodenal fistula (ADF) is a rare but potentially fatal complication of aortic aneurysm surgery with an incidence of 0.4 to 2.4%. This may occur as a primary complication of aneurysm repair or may present several years after surgery.

Pathology

Most commonly involve the third or fourth parts of the duodenum but may involve the small bowel or colon .

Pathogenesis

Several mechanisms

failure to separate bowel from the graft, – adhesion between aorta and duodenum with persistent repetitive pulsations results in pressure necrosis

Contamination of the graft with GI organisms is common.

Clinical

high index of suspicion -unexplained GI bleeding and a previous history of aortic aneurysm repair.Approximately 50% present with haematemesis or melena Massive stuttering hemorrhage – Also abdominal pain and a pulsatile mass.

Imaging

CT with and without contrast study of choice Endoscopy is udsual to exclude other more common causes of GI hemorrhage,

Aorto-duodenal Fistula

43238 hx 75M with a history of AAA repair presents with rapid lower GI LGI bleed hemorrhage hypotension and now stable duodenum wall fx thickened fx loss of soft tissue plane with aorta fx high density aorta fx mural hematoma dx aortoduodenal fistula CTscan Courtesy Ashley Davidoff MD

Treatment

Surgical treatment usually – associated with a mortality of 25 to 90%.