Aortoduodenal syndrome is a very rare condition characterized by nausea, vomiting,
abdominal pain, malnourishment, and weight loss. Aortoduodenal syndrome is caused
by an upper gastrointestinal obstruction due to an abdominal aortic aneurysm. Most
patients are treated with open surgery with abdominal aortic aneurysm repair and gastro-enteral
anastomosis or endovascular therapy [1]
[2]
[3]. Endoscopic ultrasound (EUS)-guided gastrojejunostomy with lumen-apposing metallic
stents (LAMS) is a technique to create a fistula between the stomach and the jejunum
to relieve symptoms in case of gastric outlet obstruction. We describe the first case
of aortoduodenal syndrome managed endoscopically with EUS-guided gastroenterostomy.
The patient is an 80-year-old man with severely generalized arteriosclerosis, chronic
obstructive pulmonary disease GOLD III with home oxygen treatment, and an abdominal
aortic aneurysm measuring 56 mm in diameter ([Fig. 1]). Twelve months prior to consultation, he had been admitted several times with respiratory
failure and aspiration pneumonia. His complaints were constant satiety, nausea, abdominal
pain, vomiting, and weight loss. Computed tomography (CT) scan revealed severe gastric
and duodenal retention and enlargement of the horizontal duodenum, where an infrarenal
abdominal aortic aneurysm caused compression of the bowel. The patient was deemed
unfit for surgery. A nasoenteral tube was initially placed for decompression of the
stomach after we observed clinical improvement. After consent, we performed an EUS-guided
gastroenterostomy with a 15 mm LAMS (Hot Axios; Boston Scientific, Marlborough, Massachusetts,
USA) using a freehand technique. The procedure lasted 30 min under general anesthesia.
The patient was able to start on liquid fluids after 24 hours. His condition gradually
improved, and he was discharged after 3 days. During 15 months of follow-up, the patient
experienced neither aspiration pneumonia nor a relapse of respiration failure. A CT
scan of the abdomen 9 months after EUS-guided gastroenterostomy showed normalization
of the gastric and duodenal distention. This is the first known case of aortoduodenal
syndrome that has been treated endoscopically, and it demonstrates that EUS-guided
gastroenterostomy may be an option for treating patients with aortoduodenal syndrome
who are unfit for surgery.
Fig. 1 Computed tomography scan showing the aortic aneurysm, distended stomach, and duodenal
obstruction.
Video 1 Endoscopic treatment of aortoduodenal syndrome.
Endoscopy_UCTN_Code_TTT_1AS_2AG
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