Haemorrhagic shock due to primary aortoduodenal fistula

The case history is presented of a 68-year-old man with a primary aortoduodenal fistula. Primary aortoduodenal fistulas are a rare complication of aortic aneurysms. Given a high degree of suspicion, this otherwise lethal disease can successfully be treated by surgery. The so-called herald bleed usually allows time for investigation and diagnosis. In emergency operations, a primary repair of the duodenum and replacement of the aortic aneurysm with a Dacron prosthesis is advised. Decompression of the duodenum, protection of the graft with an omentum flap and prolonged antibiotics can minimize the risk of postoperative complications. The diagnostic and therapeutic approach is reviewed.