What lies beneath a duodenal clot? Direct endoscopic diagnosis of a secondary aorto-duodenal fistula

Aortoenteric fistula (AEF) is defined as the abnormal communication between the aorta and the gastrointestinal tract.AEFs are divided into primary and secondary usually after abdominal aortic aneurysm (AAA) recovery and are a rare but quite dangerous cause of gastrointestinal bleeding that the general surgeon may face during his/her career.Secondary AEF was first described in 1953 to a 44-year-old woman 3 months after an AAA operation.This review presents the role of the surgeon in the management of secondary aortoenteric fistulas.AEFs are a rare but fatal gastrointestinal bleeding cause that the general surgeon may be asked to manage.Diagnosis requires the combination of strong clinical suspicion and the presence of a history of AAA surgery.Although a vascular surgery case, general surgeons play a role in choosing the technique of restoring the intestinal tract, which seems to be significantly related to subsequent morbidity and mortality.