Korean J Gastroenterol.  2021 Mar;77(3):132-135. 10.4166/kjg.2021.006.

Primary Aortoduodenal Fistula Causes Massive Melena: A Case Report

• Kim BY
• Kim KB

• KMID: 2514089
• DOI: http://doi.org/10.4166/kjg.2021.006

Abstract

A primary aortoenteric fistula is defined as the spontaneous development of communication between the gastrointestinal tract and the native aorta. This is unlike a secondary aortoenteric fistula that occurs after surgery, such as a vascular graft. A primary aortoenteric fistula is an extremely rare cause of upper gastrointestinal bleeding. The condition is often overlooked because of its extremely low incidence. This paper reports a case of a 75-year-old man who presented with massive melena. Esophagogastroduodenoscopy revealed an ulcer measuring approximately 1.3 cm with a huge pulsating vessel in the third portion of the duodenum. Later, the diagnosis of primary aortoduodenal fistula was confirmed. The patient died in the preoperative stage due to massive bleeding. The findings of this case suggest that the endoscopists should recognize aortoenteric fistula as a potential cause of gastrointestinal bleeding.

Keyword

Gastrointestinal hemorrhage; Melena; Endoscopy; Fistula; Ulcer

Figure

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  Fig. 1 Duodenal ulcer with a pulsating huge vessel at the inferior duodenal flexure. (A) Duodenal ulcer as viewed from the second portion of the duodenum. (B) Duodenal ulcer observed in the proximal third portion of the duodenum. Large blood vessels with pulsation are also observed. The yellow arrows indicate the duodenal ulcer suggesting the presence of an aortoenteric fistula.

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  Fig. 2 Abdominal computed tomography (CT) scan shows an infrarenal abdominal aortic aneurysm measuring 5 cm, along with an adjacent fat strand abutting the small bowel. (A) Coronal view of the abdominal CT scan. (B) Axial view of the abdominal CT scan. The yellow arrows indicate the suspected site of the aortoenteric fistula.

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