Kubota Jun, Ichita Chikamasa, Nakaya Soichiro, Nishino Takashi, Sumida Chihiro, Sasaki Akiko, Hama Daisuke
Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan.
Department of Cardiovascular Surgery Shonan Kamakura General Hospital Kanagawa Japan.
DEN Open. 2025 Aug 6;6(1):e70181. doi: 10.1002/deo2.70181. eCollection 2026 Apr.
Secondary aortoduodenal fistula (sADF) is a rare but life-threatening complication after aortic graft surgery. Diagnosis is often challenging, particularly when contrast-enhanced computed tomography (CT) and endoscopy results are inconclusive. We report a case in which diagnosis was challenging due to contrast media allergy and non-diagnostic endoscopic findings, highlighting the importance of clinical suspicion in such scenarios. A 76-year-old man with a history of graft replacement for a ruptured abdominal aortic aneurysm presented with five episodes of gastrointestinal bleeding over 3 months. Despite multiple examinations, no bleeding source was identified. Eventually, after the patient developed hypovolemic shock, contrast-enhanced CT was performed with informed consent, which revealed contrast extravasation from the aorta into the horizontal portion of the duodenum. Endoscopy subsequently identified an exposed vessel in the same location, confirming the diagnosis of sADF. Endovascular aortic repair was successfully performed. This case underscores the need to consider sADF in patients with aortic grafts who present with recurrent, unexplained gastrointestinal bleeding.
继发性主动脉十二指肠瘘（sADF）是主动脉移植手术后一种罕见但危及生命的并发症。诊断往往具有挑战性，尤其是当增强计算机断层扫描（CT）和内镜检查结果不明确时。我们报告一例因造影剂过敏和内镜检查无诊断性结果而使诊断具有挑战性的病例，强调在此类情况下临床怀疑的重要性。一名76岁男性，有腹主动脉瘤破裂移植置换史，在3个月内出现5次胃肠道出血。尽管进行了多次检查，但未发现出血源。最终，在患者发生低血容量性休克后，经知情同意进行了增强CT检查，结果显示造影剂从主动脉渗入十二指肠水平部。随后内镜检查在同一位置发现了暴露的血管，确诊为sADF。成功进行了血管腔内主动脉修复术。该病例强调，对于有主动脉移植史且出现反复不明原因胃肠道出血的患者，需要考虑sADF。
