Primary aortoduodenal fistula without abdominal aortic aneurysm1
Primary aortoduodenal fistula is an uncommon entity usually associated with untreated abdominal aortic aneurysms. The third reported case of primary aortoduodenal fistula without an aneurysm is presented. The diagnosis of primary aortoduodenal fistula is often difficult to make because conventional studies, such as an upper gastrointestinal series or aortography, have not been reliable. Fiberoptic upper gastrointestinal endoscopy to the fourth portion of the duodenum has been diagnostic in 58% of secondary aortoduodenal fistulas, and this technique may be used for the diagnosis of primary aortoduodenal fistulas. Definitive operative therapy consists of repairing the duodenal fistula and aortic resection with tube graft replacement or extra-anatomic reconstruction. A review of the experience with primary aortoduodenal fistulas from the current literature is presented.