An autopsy case of primary aortoduodenal fistula complicated by both gastric carcinoma and acute gastric mucosal lesions

摘要

We present an autopsy case of aortoduodenal fistula complicated by both gastric carcinoma and acute gastric mucosal lesions(AGML). A 73-year-old man with a past history of gastric ulcer, myocardial infarction, and arteriosclerosis of the right femoral artery presented to Osaka National Hospital complaining of intermittent claudication of the right lower extremity. After a diagnosis of arteriosclerosis obliterans, percutaneous angioplasty was performed. The postoperative course was initially good. However, two weeks after the angioplasty procedure he suddenly vomited blood. Emergency endoscopy revealed both polypoid gastric carcinoma and AGML, which were considered to be the major cause of his gastrointestinal bleeding. And he died of uncontrollable gastrointestinal bleeding two weeks after this examination. Autopsy showed an atherosclerotic aneurysm of the abdominal aorta that had ruptured into the third part of the duodenum. To our knowledge, there has been no previous autopsy on a primary aortoduodenal fistula from an atherosclerotic abdominal aneurysm complicated by similar hemorrhagic gastric lesions. This case emphasizes the difficulty of making a clinical diagnosis of primary aortoduodenal fistula.