Duodenal erosion by aortorenal dacron graft

Fistulous communications between the bowel and arterial grafts present difficult problems in diagnosis and management. The majority of these cases exhibit retroperitoneal sepsis but in some instances communication between the bowel and the lumen of the arterial graft produces serious hemorrhage. In contrast, the current report describes a patient in whom bleeding occurred twelve years after insertion of an aortorenal graft and the source of bleeding was arterial erosion of an ulcer in the duodenal wall rather than an aortoenteric fistula. Removal of the graft, closure of the ulcer, and nephrectomy were effective in treating the bleeding ulcer and the renovascular hypertension.