Case report on primary and secondary aortoenteric fistula in patient.

A rare case is reported of a 77-year-old male with secondary aortoenteric fistula after earlier ligation of infrarenal aorta without any prosthetic grafting in the abdomen. The patient was admitted into our Clinic suffering from haematemesis and melaena. The combination of our patient's medical history, the endoscopic picture and MRI arteriography indicated the likelihood of a secondary aortoenteric fistula. Three years before this our patient had been successfully operated on for a primary aortoenteric fistula having an aneurysmectomy, ligation of the infrarenal aorta and an axillobifemoral bypass performed on him while the duodenum was sutured and patched with omentum. The choice of this surgical procedure was unavoidable because our patient had been operated on for a duodenal ulcer perforation 3 days before this. With the diagnosis of a secondary aortoenteric fistula very possible an urgent laparotomy was performed revealing a fistula between the third duodenal portion and the aortic stump. The duodenum was separated from the aortic stump to which a dacron patch, posterior peritoneum and omentum were sewn. Postoperatively the patient required respiratory support in intensive care for 4 days and was discharged within 8 days. Today, two years later, he continues to be in excellent condition.