Abstract
The patient is a 76-year-old man who had undergone transurethral resection of bladder tumor and intravesical BCG (Bacillus Calmette-Guérin) therapy for bladder cancer. 17 months after that, CT scan incidentally revealed an irregular saccular infrarenal aortic aneurysm, which showed a rapid dilatation and EVAR was performed emergently. Based on the clinical course, it was presumed to be a BCG-induced aneurysm, but the patient had been free of any signs of infection. 4 months later, the patient developed persistent black stools and was diagnosed as having an aorto-duodenal fistula. He underwent prosthetic vessel replacement, partial duodenal resection and omental implantation. Although he had been treated with antibiotics without signs of infection, on the 84th postoperative day, he came to our emergency room with a complaint of anorexia and general malaise. CT scan revealed a large pseudoaneurysm associated with a rupture of the proximal anastomosis of the prosthetic vessel, but he did not wish to undergo invasive treatment and died soon after admission.
