Primary aortoduodenal fistula: a case report.

Primary abdominoaortic fistula is an extremely rare cause of upper gastrointestinal (GI) bleeding. The diagnosis is frequently delayed due to the rarity of the disease and low index of suspicion by physicians. A range of invasive and non-invasive diagnostic tools are available, but helical computer tomography (CT) remains the mainstay. Surgery offers the only hope for survival. This case report presents a 47-year-old male with massive upper GI bleeding. Various diagnostic tests and an exploratory laparotomy failed to identify the diagnosis. Later, a primary aortoduodenal fistula was confirmed by CT scan which necessitated surgical repair of the fistula and a Goretex graft for the abdominal aortic aneurysm. The patient made an uneventful recovery and remained well to the first postoperative visit in the clinic 2 wk after surgery.