Georgopoulos NS, Lazaris A, Geroulakos G, Arkadopoulos N, Hatzaras I. Aortoduodenal fistula: A case report and review of literature. World J Gastrointest Surg 2026; 18(6): 116433 [DOI: 10.4240/wjgs.116433]
Corresponding Author of This Article
Nikolaos S Georgopoulos, MD, 4th Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str, Athens 12462, Attikí, Greece. nickgeorg97@gmail.com
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Surgery
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case-report
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Georgopoulos NS, Lazaris A, Geroulakos G, Arkadopoulos N, Hatzaras I. Aortoduodenal fistula: A case report and review of literature. World J Gastrointest Surg 2026; 18(6): 116433 [DOI: 10.4240/wjgs.116433]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 116433 Published online Jun 27, 2026. doi: 10.4240/wjgs.116433
Aortoduodenal fistula: A case report and review of literature
Nikolaos S Georgopoulos, Andreas Lazaris, George Geroulakos, Nikolaos Arkadopoulos, Ioannis Hatzaras
Nikolaos S Georgopoulos, Nikolaos Arkadopoulos, Ioannis Hatzaras, 4th Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Attikí, Greece
Andreas Lazaris, George Geroulakos, 1st Department of Vascular Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 12462, Attikí, Greece
Author contributions: Georgopoulos NS and Hatzaras I contributed to methodology; Georgopoulos NS, Hatzaras I, Geroulakos G, Arkadopoulos N, and Lazaris A contributed to writing - review and editing; Georgopoulos NS and Hatzaras I contributed to data curation, writing - original draft; Geroulakos G and Hatzaras I contributed to conceptualization; Georgopoulos NS contributed to investigation; Geroulakos G contributed to visualization and supervision. All authors approved the submitted version.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Nikolaos S Georgopoulos, MD, 4th Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 1 Rimini Str, Athens 12462, Attikí, Greece. nickgeorg97@gmail.com
Received: November 12, 2025 Revised: December 19, 2025 Accepted: March 24, 2026 Published online: June 27, 2026 Processing time: 219 Days and 18.4 Hours
Abstract
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.
Core Tip: Aortoduodenal fistula is a rare but life-threatening cause of gastrointestinal bleeding requiring urgent surgical intervention. Management requires definitive aortic repair combined with tailored duodenal reconstruction. Small, viable defects are typically treated with primary repair and omental coverage, whereas larger or complex injuries may necessitate jejunal serosal patching, vascularized flaps, or Roux-en-Y duodenojejunostomy. Pyloric exclusion is reserved for selected cases. An individualized approach based on defect size and tissue viability is essential. We report a 79-year-old man with prior open abdominal aortic aneurysm repair who developed an aortoduodenal fistula and was successfully treated with bovine graft reconstruction and Roux-en-Y duodenojejunostomy.
