She was found to be hypotensive. Heterogeneous mass density in the retroperitoneum obscuring the margins of the abdominal aorta. The intimal calcification of the aorta is not circumferential at several levels. Several loops of bowel including the duodenum contain fluid of increased density and are dilated. Increased density is also seen in the stomach.
Aortoduodenal fistulas are rare causes of fatal exsanguination.
Symptoms include flank and abdominal pain, hematemesis, melena and abdominal mass. Primary aortoduodenal fistulas are nearly always associated with abdominal aortic aneurysm, mostly atherosclerotic. Secondary aortoduodenal fistulas complicating aortic reconstructive surgery are far more common. The third and fourth parts of the duodenum are the most common sites in all types of aortoenteric fistula. Diagnosis of a primary aortoenteric fistula is difficult, especially in the absence of melena or hematemesis.