A Case of Graft Duodenal Fistula Occurring after Operation for Thoracoabdominal Aortic Pseudoaneurysm Associated with Behçet's Disease

(First Department of Surgery, Chiba University School of Medicine, Chiba, Japan)

Toshiaki Ohto Masahisa Masuda Naoki Hayashida
Yoko Pearce Mitsuru Nakaya Hitoshi Shimura
Kenji Mogi Nobuyuki Nakajima
A 41-year-old woman was given a diagnosis of Behçet's disease at age 25. When she was 31, a large aortic pseudoaneurysm developed near the left renal artery. Isolation of the aneurysm and anatomical grafting and ancillary bypass were performed. Ten years later, a graft duodenal fistula developed. Extra-anatomical reconstruction was done after complete resection of the original graft and the infectious lesion. It was found that the intra-abdominal organs were receiving blood supply only from the inferiol mesenteric artery. Moreover, severe ischemia of the intra-abdominal organs was a concern during surgery. Therefore, hepatic vein oxygen saturation was monitored continuously with a Swan-Ganz catheter for ischemia of the intra-abdominal organs. It proved to be a very effective indicator and we could perform this operation safely. Reoperation of grafting is often inevitable in patients with Behçet's disease. Also, two stumps of abdominal aorta were left in this patient because of the extra-anatomical reconstruction. Pseudoaneurysm may later occur at the site of the stumps, thus necessitating careful follow-up observations.
@Jpn. J. Cardiovasc. Surg. 31F337-340 (2002)