title: Primary aortoenteric fistula: should enhanced computed tomography be considered in the diagnostic work-up?
abstract: We present the case of a 66-yr-old woman who was admitted to a surgical intensive care unit with life-threatening rectal bleeding. Despite the use of angiography and repeated computed tomography scans, the diagnosis of a primary aortoduodenal fistula secondary to an abdominal aortic aneurysm was not made, leading to a delay in diagnosis until the time of surgery. The reliability of radiological investigations and the importance of being alert to the possibility of this extremely rare condition are discussed.
  
  
  CONCLUSIONS
  We describe the delayed diagnosis of an aortoduodenal fistula related to an abdominal aortic aneurysm. We emphasize that computed tomography scan results may be unreliable for detecting this pathology in patients who are hemodynamically unstable.
authors.affiliation: *Division of Surgical Intensive Care, Department APSIC, University Hospitals of Geneva, Switzerland; †Department of Radiology, Hospital of Moulins, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Wood
authors.forename: Si-Mhamed
authors.initials: SM
authors.lastname: Bendjelid
authors.forename: Karim
authors.initials: K
authors.lastname: Bendjelid
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications*; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D004378:Duodenal Diseases / Q000000981:diagnostic imaging*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000000981:diagnostic imaging*