Aortoduodenal fistula revisited.

Two new cases of primary aortoduodenal fistula (ADF), one associated with an arteriosclerotic aneurysm and the other without, are presented and 4 cases of primary ADF without aneurysm published between 1972 and 1985 are reviewed. The anatomic relationship of the distal part of the duodenum to the infrarenal segment of the aorta, arteriosclerosis, mechanical trauma, infection and sepsis are prominent factors in the pathogenesis of ADF irrespective of its type. Intermittent haematemesis and/or melaena are the main presenting symptoms in all variants of ADF and awareness of the existence of this condition is essential for its early detection. Upper gastrointestinal endoscopy including examination of the distal part of the duodenum and explorative laparotomy are important tools in the preoperative diagnostic workup specially in primary ADF without previous knowledge of the presence of an aneurysm.