Urgent Duodenectomy in a Patient with Aortoenteric Fistula

Abstract

Background: Duodenal surgery is highly complex, especially in emergency settings such as aortoenteric fistula (AEF). AEF is a rare but life-threatening complication of aortic grafts. When duodenal defects are extensive, partial duodenectomy with pancreatic preservation may offer a safe alternative to primary repair.

Case Presentation: A 57-year-old man had multiple comorbidities and a prior aortobifemoral bypass. He presented with abdominal pain, weight loss, and recurrent gastrointestinal bleeding. Initial studies were inconclusive. CT-angiography later showed a pseudoaneurysm at the proximal graft anastomosis, requiring endovascular repair with aortic endoprostheses and a “kissing-stent.” Persistent anemia led to repeat imaging, which revealed contrast extravasation and a large D2–D3 duodenal perforation with graft exposure, consistent with secondary AEF. The patient underwent urgent D3–D4 duodenectomy with pancreatic preservation, duodenojejunostomy, explantation of the infected prosthesis, aortic repair, and creation of an axillobifemoral bypass. Following a reoperation for postoperative bleeding, he made a full recovery without further complications, demonstrating successful surgical and clinical resolution of this complex case.

Partial D3–D4 duodenectomy is a reliable and effective option. It gives surgeons confidence in managing extensive duodenal defects associated with AEF.

Conclusion: Surgeons should become familiar with partial D3–D4 duodenectomy. It offers a definitive solution for complex duodenal lesions and reinforces expertise in challenging cases.