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This CT abdomen demonstrated an infrarenal saccular abdominal aortic aneurysm. It has a thick and irregular wall with surrounding fat stranding. The body of the aneurysm noted to be abuting the third and fourth part of duodenum. The stomach and duodenal also noted to be significantly distended with fluid These findings are consistent with aorto-duodenal fistula.
This patient has a past history of aorto-femoral bypass graft infection which was subsequently removed in surgery. The aorto-duodenal fistula is presumably secondary to previous chronic aorta infection/inflammation.
Thus, an aorto-duodenal fistula should always be suspected in patients who have undergone aortic graft surgery and present with hematemesis.