Primary aortojejunal fistula: A case report

Primary aortoenteric fistulae (AEFs) are extremely rare vascular entities, with fewer than 250 cases reported in the world medical literature as of 19 96. incidence is less than 1 per cent, with a mortality ranging from 33 to 85 per cent. Atherosclerosis remains the most common etiology, accounting f or more than two-thirds of the cases reported. Other etiologies include car cinoma, ulcers, gallstones, diverticulitis, appendicitis, and foreign bodie s. Early diagnosis is crucial for survival and mandates recognition of the typical "herald bleed." Additional findings on initial presentation frequen tly include flank pain, abdominal pain, hematemesis, melena, and an abdomin al mass. More than 80 per cent of primary AEFs involve the duodenum, with t he overwhelming majority located in the third or fourth portion. Successful management of primary AEF requires a high index of suspicion for diagnosis and prompt surgical intervention for survival.