A CASE OF PRIMARY AORTODUODENAL FISTULA

Abstract

A case of primary aortoduodenal fistula caused by a very small aortic aneurysm is reported and the 22 primary aortoenteric fistulas in the Japanese literature were analyzed. The patient was a 75-year-old male with a previous history of gastrectomy. He was admitted to our hospital for massive hematemesis and melena. After admission, episodes of massive gastrointestinal hemorrhage and shock recurred. However neither repeated endoscopy nor abdominal angiography could reveal the sourse of bleeding. Explorative laparotomy was carried out, but no obvious bleeding source was identified and the remnant of stomach was resected. Postoperatively, the episodes of gastrointestinal hemorrhage continued and he died on the 9th postoperative day. At autopsy, a saccular aortic aneurysm measuring 1.0 × 0.8 cm just proximal to the orfice of the inferior mesenteric artery was found. This aneurysm perforated into the third portion of the duodenum and formed an aortoduodenal fistula. Histologically, it was considered an atherosclerotic aneurysm. In the Japanese literature, 22 cases of primary aortoenteric fistula are reported. However there were no patients with a small aortic aneurysm as in our case.