Primary aortoduodenal fistula. Case presentation and review of literature.

One hundred and twelve cases of primary aortoduodenal fistulas were reviewed. The most common etiological agent was an atherosclerotic infrarenal abdominal aortic aneurysm. There was a male to female predominance of 9:2 with an average age of 62 years. Most fistulas occurred between an infrarenal aneurysm and the third portion of the duodenum because of the relatively fixed position of the duodenum and its direct anatomical relationship posteriorly with the aorta. Patient symptoms may vary from abdominal or back pain with gastro-intestinal bleeding to just hematemesis or melena. Twenty per cent gave a history of abdominal aneurysm while up to 70% may have an abdominal mass on physical examination at the time of admission. Tentative diagnosis is established by history and physical examination with duodenoscopy, barium duodenogram and angiography available only if temporally feasible. Surgical exploration is the only treatment with resection of the aneurysm, synthetic graft placement and duodenal suturing as the procedure of choice.