IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Aortoduodenal fistula

Case contributed by Bálint Botz
Diagnosis certain

Presentation

Prior aortobifemoral and femorofemoral crossover bypass graft surgery. Severe, acute upper GI bleeding, hemodynamically unstable, in hypovolemic shock.

Patient Data

Age: 80 years
Gender: Male
ct

On the noncontrast scan hyperdense content is visible in the distended esophagus, stomach, and proximal small bowel. 

During the arterial phase intense, active contrast extravasation is visible from the aorta, which fills the duodenum and significantly expands on the late phase acquisitions. 

Collapsed IVC in line with hypovolemic shock due to exsanguination.

The right branch of the aortobifemoral bypass graft is occluded. The crossover bypass graft is also obstructed. Diminished, patchy renal enhancement due to shock.

Severe atherosclerosis, bilateral renal artery stenosis, gallstones. 

Note: The number of slices has been reduced. 

Case Discussion

Aortoduodenal fistula with profound active bleeding and signs of resultant severe hypovolemic shock. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.