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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 7, 2009; 15(25): 3191-3193
Published online Jul 7, 2009. doi: 10.3748/wjg.15.3191
Published online Jul 7, 2009. doi: 10.3748/wjg.15.3191
Enigma of primary aortoduodenal fistula
Miklosh Bala, Avraham I Rivkind, Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
Jacob Sosna, Liat Appelbaum, Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
Eran Israeli, Department of Gastroenterology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
Author contributions: Bala M and Rivkind AI analyzed the data and wrote the paper; Sosna J and Appelbaum L contributed equally to the work with radiological assistance; Israeli E provided gastroenterological assistance.
Correspondence to: Miklosh Bala, Department of General Surgery, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel. mikloshbala@gmail.com
Telephone: +972-2-6778800
Fax: +972-2-6449412
Received: April 14, 2009
Revised: April 21, 2009
Accepted: April 28, 2009
Published online: July 7, 2009
Revised: April 21, 2009
Accepted: April 28, 2009
Published online: July 7, 2009
Abstract
A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.