Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient.
10.3346/jkms.2004.19.2.302
- Author:
Yong Pil CHO
1
;
Gil Hyun KANG
;
Myoung Sik HAN
;
Hyuk Jai JANG
;
Yong Ho KIM
;
Je ho RYU
;
Chang Kyun PARK
;
Sung Gyu LEE
Author Information
1. Department of Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea. ypcho@gnah.co.kr
- Publication Type:Case Report
- Keywords:
Aortic Aneurysm;
Fistula;
Duodenum;
Sepsis;
Surgery
- MeSH:
Aged;
Aortic Aneurysm, Abdominal/complications/*pathology/*surgery;
Chronic Disease;
Digestive System Surgical Procedures;
Duodenum/pathology;
Human;
Intestinal Fistula/complications/*pathology/*surgery;
Male;
Sepsis/*complications;
Tomography, X-Ray Computed
- From:Journal of Korean Medical Science
2004;19(2):302-304
- CountryRepublic of Korea
- Language:English
-
Abstract:
Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.
