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RADIOLOGY: AORTA: Case# 39: AORTO-ENTERIC FISTULA; S/P GRAFT. This is a 79 year old male who is S/P repair of ruptured aortic aneurysmwith aortoiliac grafts. He presents now with upper GI hemorrhage. There is a large amount of high attenuation material within the bowel lumen, particularly in the duodenum and mid small bowel. There is also high and low attenuation density surrounding the aortic graft extending into the left anterior pararenal space. Gas is noted around the aorta and within these retroperitoneal collections. No active sites of contrast extravasation are demonstrated. Aortoenteric fistula accounts for 10% of small bowel bleeding. It isusually related to prosthetic aortic grafts, with 80% of fistulas forming with the duodenum where it crosses over the aorta. It may be seen as soon as three weeks following graft surgery.Typical findings include gas in the retroperitoneal soft tissues near the fistula site and loss of the normal fat plane between the duodenum and the aorta.

Peter Anderson
aorta, radiology