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Fatal secondary aortoduodenal fistula diagnosed with postmortem computed tomography angiography

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Abstract

Secondary aortoduodenal fistula (AEF), although less rare than its primary form, is an uncommon and frequently lethal cause of gastrointestinal (GI) bleeding. We report a case of fatal GI hemorrhage in a woman with a remote history of endovascular graft repair of an abdominal aortic aneurysm. Postmortem examination included computed tomography (PMCT) and CT angiography (PMCTA), which revealed air in the aorta, loss of the fat plane between the aorta and duodenum, and direct extravasation of contrast from the aorta into the duodenum. To our knowledge, this is the first published report of secondary AEF diagnosed by PMCT and confirmed with PMCTA. We propose a set of imaging criteria by which PMCTA can be used to supplant traditional anatomical dissection in the medicolegal investigation of deaths due to AEF.

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Authors and Affiliations

  1. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

    Ariel Gershon, Christopher G. Ball & Andrew S. Williams

  2. Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

    D’Arcy Little

  3. Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, University of Toronto, Toronto, Ontario, Canada

    Christopher G. Ball & Andrew S. Williams

Authors
  1. Ariel Gershon
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  2. D’Arcy Little
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  3. Christopher G. Ball
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  4. Andrew S. Williams
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Correspondence to Andrew S. Williams.

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Gershon, A., Little, D., Ball, C.G. et al. Fatal secondary aortoduodenal fistula diagnosed with postmortem computed tomography angiography. Forensic Sci Med Pathol 16, 515–518 (2020). https://doi.org/10.1007/s12024-020-00256-x

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  • DOI: https://doi.org/10.1007/s12024-020-00256-x

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