Primary aortoduodenal fistula. Diagnosis by computed tomography.

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Computed tomography in a symptomatic but stable patient enabled preoperative evaluation and even diagnosis of abnormal communications, real or incipient, between the vascular and enteric system. This case demonstrated the effectiveness, ease, and low cost of documenting a primary aortoduodenal fistula. Surgical results were ultimately improved by initiating early intervention and aggressive management. Therapeutic principles included early intervention with aneurysmectomy, duodenorrhaphy, and extra-anatomic bypass. Anatomic graft placement may be acceptable in selected cases.