Summary
This report describes a case of primary aortoduodenal fistula (PADF) in an 83 year-old male admitted to a local hospital with massive hematemesis. Endoscopy failed to reveal the site of hemorrhage. During his course, he had two episodes of hematemesis and melena. On the 77th hospital day, he died of acute hemorrhagic shock resulting from massive hemorrhage in the gastrointestinal tract. An autopsy revealed adhesion and a fistulous communication between an atherosclerotic abdominal aneurysm and the third portion of the duodenum. Primary aortoenteric fistula (PAEF), including PADF, is an uncommon but lethal complication of aortic aneurysm. Since fistula formation occurs most frequently between the abdominal aorta and duodenum, upper gastrointestinal endoscopic examination and aortography at the earliest possible moment are necessary to obtain a correct diagnosis before surgery.
Similar content being viewed by others
References
Robbins JA, et al: Aortoenteric fistula—Diagnosis and management. Dis Colon Rectum 1984, 27(3): 196
Takahashi K, et al: A case of a tuberculous abdominal aortic aneurysm which ruptured and perforated the sigmoid. J Jpn Surg Soc 1986, 87: 99
Takenaka H, et al: Rupture of tuberculous abdominal aortitis into appendix. J Jap Coll Angiol 1976, 16: 605
Hiraiwa T, et al: A case of successfully resected abdominal aortic aneurysm complicated with arteriocolic fistula. J Jpn Surg Soc 1986, 87: 818
Sweeney MS, et al: Primary aortoduodenal fistula: manifestation, diagnosis, and treatment. Surgery 1984, 96: 492
Cooper SA: cited from aortoenteric fistula—An uncommon complication of abdominal aortic aneurysms. Br J Surg 1972, 59: 458 (Reckless JPD, et al)
Elliot Jr JP, et al: Aortoenteric and paraprostheticenteric fistulas—Problems of diagnosis and management. Arch Surg 1974, 108: 479
Levy MJ, et al: Aorticointestinal fistulas following surgery of the aorta. Surg Gynecol Obstet 1965, 120: 992
Rosato FE, et al: Aorto-intestinal fistula. J Thorac and Cardiovasc Surg 1967, 53: 511
Champion MC, et al: Aortoenteric fistula-incidence, presentation, recognition, and management. Ann Surg 1982, 195: 314
Reckless JPD, et al: Aortoenteric fistulae—An uncommon complication of abdominal aortic aneurysms. Br J Surg 1972, 59: 458
Tyson RR, et al: Iliaco-appendiceal fistula following Dacron aortic graft. Am Surg 1969, 35: 241
Brand EJ, et al: Aortoduodenal fistula—Endoscopic diagnosis. Dig Dis Sci 1979, 24: 940
Perdue Jr GD, et al: Impending aortoenteric hemorrhage — The effect of early recognition on improved outcome. Ann Surg 1980, 192: 237
Pinkerton Jr JA: Aortoduodenal fistula. JAMA 1973, 225: 1196
Bussetil RW, et al: Pathogenesis of aortoduodenal fistula, experimental and clinical correlates. Surgery, 1979, 85: 1
Rosenthal D, et al: Positive blood culture as an aid in the diagnosis of secondary aorto-enteric fistula. Arch Surg 1979, 114: 1041
West JP, et al: Anastomotic false aneurysms. Arch Surg 1971, 103: 348
Pfeiffer Jr RB: Successful repair of three primary aortoduodenal fistulae. Arch Surg 1982, 117: 1098
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Yano, H., Jimi, A., Kojiro, M. et al. Primary aortoduodenal fistula. Gastroenterol Jpn 22, 218–221 (1987). https://doi.org/10.1007/BF02774220
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02774220