A rare presentation of ruptured abdominal aortic aneurysm leading to aortoduodenal syndrome

Unique case of abdominal aortic aneurysm causing obstructive jaundice and duodenal obstruction

Obstruction of the duodenum by an abdominal aortic aneurysm (AAA) (aortoduodenal syndrome) has rarely been reported. It presents with symptoms of upper gastrointestinal (GI) tract obstruction. Obstructive jaundice caused by an AAA is also extremely rare and requires high clinical suspicion. We present a unique case with informed consent of an elderly gentleman who presented with both rare presentations over a course of few months. After extensive literature search, we have found case reports of patients showing either of the two unusual presentations, but none were found to show them together.

Duodenal Obstruction after Endovascular Repair of a Ruptured Abdominal Aorta Aneurysm

Endovascular repair has become the most frequent approach in the management of the ruptured infra-renal abdominal aorta aneurysm. When managing the ruptured patient with a significant retroperitoneal hematoma, abdominal compartment syndrome is often a consideration. Duodenal obstruction from the hematoma is rare and not typically a consideration. In the case of our patient, the intra-abdominal pressures were successfully managed conservatively. The large retroperitoneal hematoma, however, encased and obstructed the duodenum ultimately requiring a gastrojejunostomy. Similar rare cases of duodenal obstruction have been reported after open aortic repairs. We have not identified other cases in the literature of duodenal obstruction after endovascular management of a ruptured abdominal aorta aneurysm. We want to raise awareness to the possibility. In our opinion, conservative management would still be the preferred course of action, even if surgical management was ultimately required for the duodenal obstruction, as it reduces the initial insult in the patient with the aneurysmal rupture.

Abdominal aortic aneurysm and its association with duodenal obstruction: aortoduodenal syndrome

Proximal small bowel obstruction in the region of the duodenum is an uncommon clinical entity. Our case, which involves obstruction of the third portion of the duodenum due to an abdominal aortic aneurysm (AAA), is even more unusual. A review of the relevant literature regarding duodenal obstruction due to extrinsic compression includes features that differentiate aortoduodenal syndrome from superior mesenteric artery syndrome. Management of these conditions range from conservative to surgical, of which now includes a more recent role of metallic stents in some instances.