Endoscopic visualization of an intraluminal dacron graft: definitive diagnosis of aortoduodenal fistula

The literature contains more than 250 cases of graft enteric fistula. The classic symptom complex involves antecedent bleeding followed by exsanguinating hemorrhage within hours to days. In patients with gastrointestinal hemorrhage and a history of aortic graft implantation, the role of endoscopy is crucial, first to delineate any coexistent disease and secondarily to view the fistula itself. Although only 20 cases have been so diagnosed, aggressive intubation of the distal duodenum in a patient fully prepared for surgical intervention may yield a definitive diagnosis of aortoduodenal fistula, thus facilitating appropriate aggressive surgical management.