Pancreas sparing duodenectomy and aortic reconstruction with custom-made bovine pericardial tubular graft for primary aorto duodenal fistula. Case report.

Primary aorto-duodenal fistula (PADF) is a rare life-threatening condition consisting in a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention. PADF results most commonly from an abdominal aortic aneurism (AAA) or aortic bacterial/mycotic infection, with the fistula forming between the native aorta and the third or fourth portion of the duodenum. Symptoms are nonspecific and the diagnosis is often delayed after AAA rupture with high rate of morbidity and mortality. We present a case of 69-year-old-male with a history of untreated abdominal aortic aneurysm who came to the attention of the emergency department for Abdominal aortic aneurysm rupture (RAAA). The patient was successfully treated with staged therapy: endovascular aneurysm repair (EVAR) to control hemorrhage rapidly, followed by pancreas sparing duodenectomy and aortic reconstruction with xenopericardial tube grafts. KEY WORDS: Biological graft, Bovine pericardial tubular graft, Primary aorto-duodenal fistula, Pancreas sparing duodenectomy.