Multifaceted surgical approach of combined thoracoretroperitoneal incision and midline abdominal incision for a secondary aortoenteric fistula

J Cardiothorac Surg. 2024 Jan 28;19(1):29. doi: 10.1186/s13019-024-02496-2.

Abstract

Background: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach.

Case presentation: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications.

Conclusions: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.

Keywords: Midline abdominal incision; Secondary aortoenteric fistula; Thoracoretroperitoneal incision.

Publication types

  • Case Reports

MeSH terms

  • Aorta / surgery
  • Aorta, Abdominal / surgery
  • Aortic Aneurysm, Abdominal* / complications
  • Aortic Aneurysm, Abdominal* / surgery
  • Aortic Diseases* / etiology
  • Aortic Diseases* / surgery
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Duodenal Diseases* / complications
  • Duodenal Diseases* / surgery
  • Humans
  • Intestinal Fistula* / etiology
  • Intestinal Fistula* / surgery
  • Male
  • Middle Aged
  • Surgical Wound*
  • Vascular Fistula* / complications
  • Vascular Fistula* / surgery