Surgical images. Aortoduodenal fistula

An 81-year-old man was seen at another centre with profound rectal bleeding, hypotension and a history of intermittent syncope for 3 days. He denied having any abdominal or back pain. His medical history included repair of an infrarenal abdominal aortic aneurysm with an aortobifemoral bypass graft 13 years previously. His hemoglobin level was 62 g/L. Upper gastrointestinal endoscopy demonstrated active bleeding in the fourth part of the duodenum.