Tsuneki Takao, Yuasa Yasuhiro, Nishino Takeshi, Tomibayashi Atsusi, Motoki Tatsuo, Fukumura Yoshiaki
Department of Surgery, Tokushima Red Cross Hospital, Japan.
Department of Surgery, Tokushima Red Cross Hospital, Japan.
Int J Surg Case Rep. 2022 May;94:107147. doi: 10.1016/j.ijscr.2022.107147. Epub 2022 May 4.
Secondary aortoduodenal fistula (sADF) is a complication of prosthetic graft replacement of the abdominal aorta which often follows a fatal course. This report details our experience with a case of lymphatic fistula that developed after sADF repair. The fistula was refractory to conservative treatment but ultimately responded to lipiodol lymphangiography.
A 75-year-old man had undergone prosthetic graft replacement to treat an abdominal aortic aneurysm in 2012 and a thoracic aortic aneurysm in 2015. Upper gastrointestinal endoscopy was performed in 2020, and examination for worsening anemia revealed that the abdominal aortic graft had eroded into the horizontal duodenum. The patient was treated with prosthetic graft replacement and duodenectomy. A refractory lymphatic fistula was noted after surgery, which made ascites accumulation difficult to control, but the patient's condition rapidly improved following therapeutic lymphangiography.
Surgery is the first-line therapy for sADF, but clinicians must stay vigilant for infection recurrence and aortoenteric fistulae after a repair, and this requires patient-specific postoperative management. Our modifications, intended to minimize contamination of the operative field in the present case, also facilitated our ability to subsequently treat a refractory lymphatic fistula, which is a rare postoperative complication of the procedure.
Procedural modifications to sADF repair aimed at minimizing perioperative contamination are crucial for preventing infection recurrence. Given the extent of invasion, the surgery can cause various postoperative complications, requiring individualized strategies for management and treatment. Therapeutic lymphangiography is one such approach, which holds promise as a first-line treatment for refractory lymphatic fistula.
继发性主动脉十二指肠瘘（sADF）是腹主动脉人工血管置换术后的一种并发症，通常预后不良。本报告详细介绍了我们处理一例sADF修复术后发生的淋巴瘘的经验。该瘘对保守治疗无效，但最终对碘油淋巴管造影有反应。
一名75岁男性在2012年接受了人工血管置换术治疗腹主动脉瘤，2015年接受了胸主动脉瘤治疗。2020年进行了上消化道内镜检查，针对贫血加重的检查发现腹主动脉移植物已侵蚀至十二指肠水平部。患者接受了人工血管置换术和十二指肠切除术。术后发现难治性淋巴瘘，导致腹水难以控制，但在进行治疗性淋巴管造影后患者病情迅速改善。
手术是sADF的一线治疗方法，但临床医生必须警惕修复术后感染复发和主动脉肠瘘，这需要针对患者的术后管理。我们在本病例中旨在尽量减少手术野污染的改进措施，也有助于我们后续治疗难治性淋巴瘘，这是该手术罕见的术后并发症。
旨在尽量减少围手术期污染的sADF修复手术改进措施对于预防感染复发至关重要。鉴于手术的侵袭范围，该手术可导致各种术后并发症，需要个体化的管理和治疗策略。治疗性淋巴管造影就是这样一种方法，有望成为难治性淋巴瘘的一线治疗方法。
