Primary aortoduodenal fistula complicated by abdominal aortic aneurysm

A 74-year-old male patient was operated in Vakif Gureba Hospital for aortod uodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and compu ted tomography in another center. Appearing of melena and hematemesis gastr oduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the pat ient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal ab dominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnec ted. Following aneurysmotomy a prosthetic graft was placed in the aortobiil iac position. The patient was discharged at the 42nd postoperative day. Pri mary aortoenteric fistula is a very rare con sequence of untreated abdomina l aortic aneurysm. The segments of intestine most frequently involved in ao rtoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical p resentation is recurrent episodes of gross gastrointestinal haemorrhage. Th ese cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.