Secondary Aortoduodenal Fistula Complicating Aortic Grafting, as a Cause of Intermittent Chronic Intestinal Bleeding

Intermittent intestinal bleeding persisted in a 77-year-old male, who had undergone grafting for abdominal aortic aneurysm. Each attack lasted for a few weeks and spontaneously resolved. Only a minute abnormality was found in the third portion of the duodenum; barium studies showed a segmental narrowing, but endoscopy disclosed only a small erosion in that portion. Massive and fatal gastrointestinal hemorrhage broke out 6 months after the onset of bleeding. Autopsy revealed an adhesion area with a small fistula formation between the duodenum and aorta. Evenslight endoscopic findings should be considered suggestive of aortoenteric fistula in patients after aortic surgery.(Internal Medicine 37: 47-50, 1998)