Secondary aortoduodenal fistula. Rare endoscopic finding in the course of digestive hemorrhage

Secondary aortoduodenal fistula is a rare and life-threatening long-term co mplication of abdominal aortic surgery. Pathogenesis is often not clear; bo th mechanical trauma and septic procedures are involved as principal factor s. The interval between first intervention and development of the fistula c an vary from months to years. The presentation is often subtle with a heral d bleeding followed by a period of grace, followed or not by an exsanguinat ing hemorrhage. The right diagnosis of aortoduodenal fistula hemorrhage can be difficult. We emphasize the need to have an early and correct diagnosis in one with differential diagnosis of patients with gastrointestinal bleed ing after previous abdominal aortic replacement surgery. The esophagogastro duodenoscopy (until the Treitz) is the main diagnostic procedure, able to d emonstrate the fistula and rule out other possible causes of bleeding.