title: Role of endoscopy in the diagnosis of aneurysm-duodenal fistula.
abstract: BACKGROUND
  Aneurysms complicated by enteric fistulae are uniformly fatal clinical conditions and therefore should be placed high on the list of possible diagnoses in any patient with aneurysmal disease and gastrointestinal bleeding. A number of different diagnostic techniques have been proposed, but most of them are usually of little help or even misleading.
  
  
  METHODS
  Between May 2000 and April 2002, endoscopy was performed in 290 consecutive patients with upper gastrointestinal bleeding. We retrospectively evaluated that endoscopy may provide an important diagnostic clue in aneurysm-enteric fistulae.
  
  
  RESULTS
  Three patients with gastrointestinal bleeding presented with aneurysmal disease complicated by duodenal fistula formation. Two patients presented with aortoduodenal fistula, and the last one hepatic artery aneurysm with duodenal fistula formation. In all of our cases, endoscopic findings were suggestive and helpful for the preoperative diagnosis.
  
  
  CONCLUSIONS
  Considering that prompt aggressive surgical intervention is mandatory for survival and more than 90% of aneurysmal disease with duodenal fistula formation should be within range of the endoscopists, aggressive and thorough endoscopy with a high index of clinical suspicion seems to be the most important diagnostic test in these difficult cases.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung-si, Korea.
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Cho
authors.forename: Myoung Sik
authors.initials: MS
authors.lastname: Han
authors.forename: Chul Hee
authors.initials: CH
authors.lastname: You
authors.forename: Seung Yong
authors.initials: SY
authors.lastname: Kim
authors.forename: Hyuk Jai
authors.initials: HJ
authors.lastname: Jang
authors.forename: Jee Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Yong Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Sung Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis*; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000175:diagnosis*; D004378:Duodenal Diseases / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies