Soto-Hernández G, Alvarado-Lezama J, Bizueto-Rosas H, Madrid-Mier E, Martínez-Maya H, Mejía-Valero SA

Language: Spanish
References: 16
Page: 95-101
PDF size: 313.02 Kb.

ABSTRACT

The aortoduodenal syndrome is an extremely rare complication related to an abdominal aortic aneurysm (AAA). In this clinical entity, the aneurysm sac obstructs and compresses the duodenum. Frequently, this syndrome presents with persistent vomiting associated with abdominal pulsatile tumor, and occasionally abdominal bloating, weight loss and abdominal pain. First, it is recommended to carry out the hidroelectrolitic treatment and gastric decompression; subsequently, to perform a resection of the aneurysm and to interpose an aortic graft. We present a case of an octagenarius patient with an aortoduodenal fistula which was evidenced by bleeding associated with a broken infrarrenal AAA that was contained by surrounding tissues and compressing the duodenum, diagnosed by CT angiography; During the surgical intervention, we found an organized hematoma in the anterior surface of the aneurysm involving the duodenum with erosion and stenosis caused by inflammatory process. The aneurysm was resected as well as third and fourth portion of the duodenum including gastric necrosis by performing a gastroyeyuno-anastomosis and biliary duct bypass through probe in T. Further, we performed an axillo-bifemoral bypass with a synthetic graft. Finally, the patient died during her stay in the ICU.

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