Vascular Pathology: Vascular Disease: Iatrogenic Aorto-duodenal Fistula

A 1977 autopsy specimen from a 76 year old grocer, who presented with a vague history of weakness and pallor. On direct questioning he admitted passing black, tarry stools on several occasions in recent months. Ten years previously he had had an aortobifemoral graft repair of an abdominal aortic aneurysm. For several weeks he had been taking BrufenÃ?,Ã?,® for vague backache. Examination revealed a pale, lean gentleman with no signs of heart failure. Heart rate was regular at 96 bpm, and his blood pressure was 110/70. Bruits could be heard over both internal carotids. Hb was 8.6 and clotting studies were normal. Gastroscopy was technically difficult, with only the stomach and first part of the duodenum being visualised. No source of active bleeding was seen. Shortly after the procedure he went into hypovolaemic shock and died.