A Case of Primary Aortoenteric Fistula Mimicking Duodenal Subepithelial Tumor

ABSTRACT

Primary aortoenteric fistula is a fatal condition which poses a considerable diagnostic challenge because of its infrequency and nonspecific presentation. Here, the authors report the case of an 83-year-old man who presented with hematemesis and melena. During endoscopy, a 3 cm sized subepithelial mass with central ulceration was found in the second portion of the duodenum. At first, bleeding from a duodenal subepithelial tumor, such as, gastrointestinal stromal tumor was suspected. An endoscopic hemostasis trial failed and computed tomography (CT) scan was performed prior to possible angiographic embolization. The CT scan revealed the mass lesion observed by endoscopy as an aneurismal dilatation with fistula formation to the distal second portion of the duodenum. The patient succumbed to hypovolemic shock while preparations were being made for emergency surgery. This case provides an example of a primary aortoenteric fistula mimicking a duodenal subepithelial tumor during endoscopy.