Abstract
Aortoenteric fistula is a rare complication of aortic graft insertion surgery. A 72 year old man was admitted with a complaint of melena 13 months after aortic graft insertion. Upper GI endoscopy showed an ulcer at the 3rd portion of the duodenum markedly surrounded by granulation tissue. During the course, pulsation and fresh bleeding at the same site was often observed, and finally the diagnosis of aorto duodenal fistula (ADF) was established. By operation, marked inflammatory change was observed around the aorta, and the fistula was found between the proximal anastomosis and the 3rd portion of the duodenum. Upper GI series, aortogram, and CT scan suggested the presence of the lesion, but were not helpful to make diagnosis of ADF. Awareness of this entity is the first step to lead to the correct diagnosis. Patients who present upper gastrointestinal hemorrhage of any degree following aortic graft insertion must be examined by upper GI endoscopy as soon as possible under the suspicion of ADF.
