Primary aortoduodenal fistula caused by duodenal tuberculosis without an abdominal aortic aneurysm: Report of a case

Abstract

A 66-year-old man died of massive gastrointestinal hemorrhage caused by a fistula between the third portion of the duodenum and the abdominal aorta. An autopsy revealed that duodenal tuberculosis had resulted in the development of a fistula into the aorta with no pathological changes, and no active pulmonary tuberculosis was found. Duodenal tuberculosis and primary aortoduodenal fistula (ADF) without an aneurysm are both extremely rare. Thus, we report herein a unique case of primary aortoduodenal fistula without an abdominal aortic aneurysm, but associated with duodenal tuberculosis, and review the current literature.

Primary aortoduodenal fistulas in minimally aneurysmal aortas: imaging diagnosis

“…Brenowitz and Williams reported that less than half of the cases of primary ADF reported had a correct preoperative diagnosis and that only 25% of reported cases were palpated preoperatively, indicating that the physical examination may not be able to detect smaller primary ADFs [20]. Moreover, a palpable abdominal mass may not be evident in primary ADFs without aortic aneurysms [4]. In our cases, there was a significant hematoma surrounding the ADF, which would have further diminished palpatory accuracy.…”

“…Cooper first documented this entity in 1825 [3]. Since then, 229 cases of primary infradiaphragmatic AEFs have been reported [4], 80% of which communicate with the duodenum, with 56% involving the third portion [5]. The fixed retroperitoneal location and close proximity of the third portion of the duodenum to the aorta make it the most common site for fistula formation [6,7].…”

“…Fistulas arising from nonaneurysmal aortas are very rare, and only 16 cases before 1997 have been reported. Etiologies include carcinoma, irradiation, peptic ulcers, foreign bodies, cholecystitis, diverticulitis, and bacterial infections [6,8,9,[11][12][13][14][15][16][17] including duodenal tuberculosis [4].…”

“…In the case of primary ADF, visualization of the fistulous tract is required to make the diagnosis, which is difficult. Also, there may be difficulty in visualizing the third portion of the duodenum when there is active bleeding and pooling in the stomach [4]. A three times greater incidence of peptic ulcer disease has been documented in patients with abdominal atherosclerotic aneurysm [24], however, and endoscopy may help exclude the more common causes of GIH such as peptic ulcers, gastritis, and bleeding from esophageal varices.…”

Successful Management and Outcome of a Postoperative Aortogastric Fistula in a Patient with Recurrent Gastric Cancer: Report of a Case

“…The mechanisms for this problem are quite variable, and may involve thoracic or abdominal aortic aneurysms, [16][17][18][19] gastrostomy tube-related bleeding, 20 erosion into a esophagogastrostomy, 21 arterial bleeding into a duodenal stump, 22 or others. [23][24][25][26] All these above cases resulted in fatal outcomes. Four patients surviving an aortogastric fistula, nevertheless, have been described.…”