Geraci Girolamo, Pisello Franco, Li Volsi Francesco, Facella Tiziana, Platia Lina, Modica Giuseppe, Sciume Carmelo
University of Palermo, Section of General and Thoracic Surgery, Operative Unit of Surgical Endoscopy, Via Francesco Vermiglio 5, Palermo, Sicily, Italy.
World J Gastroenterol. 2008 Jan 21;14(3):484-6. doi: 10.3748/wjg.14.484.
Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.
主动脉十二指肠瘘（ADF）是最常见的主动脉肠瘘（占80%），表现为上消化道出血。我们报告首例患有继发性主动脉十二指肠瘘且有持续性闭塞综合征病史的男性病例。一名59岁男性5年前接受了主动脉-双股动脉搭桥手术，出现消化不良和胆汁性呕吐。计算机断层扫描显示在十二指肠第三段存在炎症组织，十二指肠与假体之间有气泡，且与十二指肠粘连。患者接受了手术，术中假体与十二指肠分离，肠道未能闭合，遂进行了胃空肠吻合术。术后过程顺利，继发性ADF是主动脉手术的一种并发症（0.3%-2%）。假体材料对肠道的机械性侵蚀是由于缺乏腹膜后组织插入、多余放置的移植物过度搏动或感染性手术所致。十二指肠第三或第四段最常受累。ADF的诊断困难。总是建议通过剖腹探查进行手术治疗。每当有主动脉假体的患者出现消化道出血或不明原因的梗阻综合征时，都必须怀疑ADF。ADF的临床表现很少很隐匿，表现为梗阻综合征，在这些情况下，主要目标是有效缓解机械性肠梗阻。
