Makimoto Shinichiro, Takami Tomoya, Shintani Hiroshi, Kataoka Naoki, Yamaguchi Tomoyuki, Tomita Masafumi, Shono Yoshiharu, Kuroyanagi Satoshi
Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan.
Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada City, Osaka, 596-8522, Japan.
Int J Surg Case Rep. 2020;69:87-91. doi: 10.1016/j.ijscr.2020.03.036. Epub 2020 Apr 1.
Aortoduodenal fistula (ADF) is a rare but life-threating condition, and it is an important cause of massive gastrointestinal bleeding. Primary ADF often occurs as a result of aortic aneurysm, and secondary ADF develops after the placement of aortic prosthetic graft.
Case 1: A 64-year-old man with hematemesis was transferred to our hospital. The patient was diagnosed with primary ADF. Thus, we performed prosthetic graft replacement for an aortic aneurysm, and suturing of the duodenal fistula and duodenojejunal side-to-side anastomosis were performed. He was then discharged on the 35th postoperative day. After 2 years and 10 months, he died of other diseases. Case 2: A 76-year-old man with a history of abdominal aortic aneurysm repair with a prosthetic graft 5 years back who presented with hematemesis and melena was transferred to our hospital. The patient was diagnosed with secondary ADF, and an emergency endovascular aneurysm repair (EVAR) and suturing of the duodenal fistula were perfomed. He was transferred for rehabilitation purposes on the 108th postoperative day but eventually died of pneumonia 6 months after surgery.
ADF is associated with high mortality. Initial bleeding is usually minor and often intermittent. However, it leads to severe bleeding and hemorrhagic shock. EVAR is preferred over open surgery because it can be performed faster and is less invasive. Recently, in case of hemorrhagic shock, EVAR is used as first-line treatment.
Accurate diagnosis and immediate treatment are important for the survival of patients with ADF.
主动脉十二指肠瘘（ADF）是一种罕见但危及生命的疾病，是导致大量胃肠道出血的重要原因。原发性ADF常因主动脉瘤引起，继发性ADF则在主动脉人工血管移植术后发生。
病例1：一名64岁男性因呕血被转至我院。该患者被诊断为原发性ADF。因此，我们对主动脉瘤进行了人工血管置换，并对十二指肠瘘进行了缝合以及十二指肠空肠侧侧吻合术。术后第35天他出院了。2年10个月后，他死于其他疾病。病例2：一名76岁男性，5年前有腹主动脉瘤人工血管修复史，因呕血和黑便被转至我院。该患者被诊断为继发性ADF，并进行了急诊血管腔内动脉瘤修复术（EVAR）和十二指肠瘘缝合术。术后第108天他因康复目的被转院，但最终在术后6个月死于肺炎。
ADF的死亡率很高。初始出血通常较少且往往是间歇性的。然而，它会导致严重出血和失血性休克。与开放手术相比，EVAR更受青睐，因为它可以更快地进行且侵入性较小。最近，在发生失血性休克的情况下，EVAR被用作一线治疗方法。
准确诊断和及时治疗对ADF患者的生存至关重要。
