Presentation
Hematemesis
Patient Data
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 abutting 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.
Additionally, there is occlusion of the distal abdominal aorta and evidence of a bypass graft (presumably an axillary femoral graft) in the right anterior abdominal wall without opacification, presumably also occluded.
Case Discussion
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.
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