Primary aortoduodenal fistula--report of an autopsy case

This report describes a case of primary aortoduodenal fistula (PADF) in an 83 year-old male admitted a local hospital with massive hematemesis. Endoscopy failed to reveal the site of hemorrhage. During his course, he had two episodes of hematemesis and melena. On the 77th hospital day, he died of acute hemorrhagic shock resulting from massive hemorrhage in the gastrointestinal tract. An autopsy revealed adhesion and a fistulous communication between an atherosclerotic abdominal aneurysm and the third portion of the duodenum. Primary aortoenteric fistula (PAEF), including PADF, is an uncommon but lethal complication of aortic aneurysm. Since fistula formation occurs most frequently between the abdominal aorta and duodenum, upper gastrointestinal endoscopic examination and aortography at the earliest possible moment are necessary to obtain a correct diagnosis before surgery.