A 65-year-old man was taken to Erebouni MC in a serious condition with gastrointestinal (GI) bleeding and immediately hospitalized in the intensive care unit. Three years ago, the patient was diagnosed with obliterating atherosclerosis of the aorta and its branches, aorto-iliac bifurcation allo-shunting was carried out. However, since the beginning of the year, recurring bleeding began, anemia and hypovolemia were diagnosed, the reason for which it was impossible to establish. After hospitalization in MC Erebouni, detailed laboratory and instrumental examinations were carried out. A multi-organ CT - angiography showed that there is a chronic dissection of the infrarenal abdominal aorta, a characteristic picture of aortitis with the presence of free gas adjacent to the wall. A defect of the posterior wall of the lower horizontal part of the duodenum was also diagnosed. Despite the intensive therapy carried out in the intensive care unit, the patient's condition was not regulated. A consultation was invited by the heads of resuscitation and surgical services. Leading specialists, after analyzing the results of the examinations, diagnosed a rare disease- aortoduodenal fistula. Considering the risks of a rare disease, it was decided to carry out an exceptional surgery. Under the leadership of Dr. Ara Vardanyan, Head of General & Thoracic Surgery Department of Erebouni MC, the surgical team-Dr. Gevorg Harutyunyan, Dr. Tigranuhi Hovsepyan, anesthesiologist Vardan Arakelyan, performed a complex and exceptional surgery- resection of the proximal duodenum, elimination of aorto-duodenal fistula, formation of a duodeno-jejuno side-to-side anastomosis, opening the phlegmon of the retroperitoneal space, the formation of a loop ileostomy, sanitation and drainage of the abdominal cavity and retroperitoneal space. The postoperative period passed without complications. He was discharged from the hospital on the 11th day with improvement.
