July 1989

Primary Aortoduodenal FistulaDiagnosis by Computed Tomography

Author Affiliations

From the Department of Surgery, The Englewood (NJ) Hospital (Drs Ibrahim and Raccuia), and the Department of Gastroenterology and Radiology, Palisades General Hospital, North Bergen, NJ (Drs Micale and Zafar).

Arch Surg. 1989;124(7):870-871. doi:10.1001/archsurg.1989.01410070130027

• A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Computed tomography in a symptomatic but stable patient enabled preoperative evaluation and even diagnosis of abnormal communications, real or incipient, between the vascular and enteric system. This case demonstrated the effectiveness, ease, and low cost of documenting a primary aortoduodenal fistula. Surgical results were ultimately improved by initiating early intervention and aggressive management. Therapeutic principles included early intervention with aneurysmectomy, duodenorrhaphy, and extra-anatomic bypass. Anatomic graft placement may be acceptable in selected cases.

(Arch Surg 1989;124:870-871)