Aortoduodenal fistula: A case report and review of literature

BACKGROUND Aortoduodenal fistula (ADF) is a rare, often catastrophic condition characterized by an abnormal communication between the abdominal aorta, or an aortic graft, and the duodenum. Although infrequently encountered, ADF is associated with massive gastrointestinal hemorrhage and high mortality if not promptly recognized and treated. This manuscript summarizes the epidemiology, pathogenesis, clinical manifestations, diagnostic modalities, management strategies, particularly in techniques for repairing the duodenum, and outcomes of ADF. CASE SUMMARY We present a case report of a 79-year-old male with a history of an open repair for a ruptured abdominal aortic aneurysm, complicated by an ADF. He was successfully treated with in-situ aortic reconstruction using a bovine pericardial graft, followed by a Roux-en-Y duodenojejunostomy. The postoperative recovery was uneventful. A review of current literature shows that primary two-layer duodenorrhaphy with omental interposition remains the most commonly reported approach for small, viable defects. For larger or complex injuries, reinforcement with a jejunal serosal patch or vascularized tissue flaps provides additional protection. Roux-en-Y duodenojejunostomy offers durable reconstruction in extensive duodenal involvement. Pyloric exclusion and other diversionary techniques have shown limited benefit and are now reserved for selected cases. CONCLUSION Optimal management of ADF requires an individualized strategy for duodenal repair in conjunction with definitive aortic reconstruction and infection control. While current evidence supports tailoring the repair technique to defect size and tissue quality, prospective data are lacking. Multicenter reporting is essential for establishing evidence-based guidelines.