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Angiographic demonstration of gastrointestinal bleeding due to aorto-duodenal fistula

Department of Radiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

This excerpt was created in the absence of an abstract.

Aorto-enteric fistula is an uncommon complication of abdominal aortic aneurism and a rare cause of gastrointestinal bleeding.

Awareness of this entity and careful timing of arteriography may, as illustrated in this case, lead to a definitive pre-operative diagnosis.

Review of the literature reveals that this is the first report of an aorto-duodenal fistula demonstrated angiographically.

A 59-year-old female was admitted with a history of two episodes of transient malaena, the first occurring one week before and the second one day before admission. There was no history of haematemesis, abdominal or back pain. She had ischaemic heart disease, familial hyperlipidaemia, and was on replacement therapy for hypothyroidism which had developed as a result of I¹³¹ therapy for non-toxic goitre.

On physical examination she was obese and had a vaguely palpable epigastric mass. Haemoglobin was 7 g%, blood pressure 150/70, and pulse rate 100 per minute. The plain abdominal radiographs, barium meal and enema, endoscopy and sigmoidoscopy were normal. She had several further brief episodes of malaena while in hospital and arteriography was planned when she next showed signs of haemorrhage.

On the 25th day after her initial rectal bleed, a selective superior mesenteric arteriogram was performed to outline the source of bleeding. This demonstrated considerable reflux of contrast agent into the abdominal aorta, outlining an aneurysm 5 cm in diameter, and a relatively dense blush appearing in the region of the third and fourth parts of the duodenal loop with spread into the second portion (Fig. 1).

Received for publication October 1, 1975.

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				P. Frassinelli, M. A. Gittleman, and K. M. McDonald Primary Aortoenteric Fistula Secondary to Ulcerative Atherosclerosis: A Case Report Vascular and Endovascular Surgery, September 1, 1995; 29(5): 411 - 415. [Abstract] [PDF]