Aorto-Duodenal Fistula After Emergency Endovascular Repair of a 14-cm Abdominal Aortic Aneurysm in a 68-Year-Old Man.

BACKGROUND Aorto-duodenal fistula (ADF) is a communication between the aorta and the duodenum and requires urgent aortic repair. However, it often leads to life-threatening complications. Thus, an early and appropriate diagnostic method is necessary to deliver adequate treatment. This report describes the case of a 68-year-old man with anaorto-duodenal fistula following emergency endovascular repair of a 14-cm abdominal aortic aneurysm (AAA) identified using oral contrast computed tomography (CT), and discusses the consequences of delayed treatment and ADF management. CASE REPORT We present a case of a 68-year-old White man with abdominal bloating, who upon further examination was diagnosed with an AAA, which was successfully treated by endovascular aneurysm repair (EVAR). However, 1 year later, an endoleak was discovered and, despite the physicians' efforts, the overall treatment was complicated due to the patient's continuous postponement of treatment over several years. The aneurysm continued to expand until it reached 14 cm. Despite the successful endovascular repair of the endoleak, a duodeno-aortic fistula (DAF) was diagnosed using CT with oral contrast. The patient was managed conservatively with aneurysmal sac drainage and antibiotic therapy, which decreased the size of the aneurysmal sac. Despite early diagnostic efforts and interventions, the patient's condition deteriorated due to further complications, ultimately resulting in death. CONCLUSIONS This case report demonstrates a potential useful diagnostic role of CT with oral contrast in detecting DAF, in situations when other methods fail to do so, and emphasizes the importance of prompt intervention to prevent life-threatening complications. However, further investigations to explore the underlying mechanism and its replicability are required.