Aortoduodenal fistula

Case contributed by Dr Balint Botz

Presentation

Prior aortobifemoral and femorofemoral crossover bypass graft surgery. Severe, acute upper GI bleeding, hemodynamically unstable, in hypovolemic shock. Aorto-enteral fistula?

Patient Data

Age: 80 years
Gender: Male
CT

On the noncontrast scan hyperdense content is visible in the distended esophagus, stomach, and proximal small bowel. 

During the arterial phase intense, active contrast extravasation is visible from the aorta, which fills the duodenum and significantly expands on the late phase acquisitions. 

Collapsed IVC in line with hypovolemic shock due to exsanguination.

The right branch of the aortobifemoral bypass graft is occluded. The crossover bypass graft is also obstructed. Diminished, patchy renal enhancement due to shock.

Severe atherosclerosis, bilateral renal artery stenosis, gallstones. 

Note: The number of slices has been reduced. 

Case Discussion

Aortoduodenal fistula with profound active bleeding and signs of resultant severe hypovolemic shock. 

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Case information

rID: 75286
Published: 24th Mar 2020
Last edited: 15th Oct 2020
System: Vascular
Inclusion in quiz mode: Included
Institution: University of Pécs

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