{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T21:23:00Z","timestamp":1773091380741,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,10,9]]},"abstract":"<jats:p>A 65-year-old man with history of aortobifemoral surgery 4 years ago was admitted to hospital after sudden abdominal pain. Initially misdiagnosed as renal colic, he was treated with analgesics, and while on observation he started with haematemesis, rapidly responding to volume infusion. Upper gastrointestinal endoscopy showed fresh blood in the stomach with no visible active bleeding. CT scan showed an important contrast extravasation from the aorta to the third duodenal portion, restarting haemodynamic instability and a cardiac arrest. Cardiopulmonary resuscitation (CPR) manoeuvres followed by intense fluid resuscitation and urgent laparotomy with a fast transabdominal supracoeliac aortic clamping was performed. After multiple blood and plasma unit transfusion and intravenous norepinephrine, two more cardiac arrests were recovered. Unfortunately, after aggressive management, the patient rapidly deteriorated and deceased on the table. Aortoduodenal fistula is a rare entity causing life-threatening bleeding. Its diagnosis requires high clinical suspicion and surgery offers the only hope for survival.<\/jats:p>","DOI":"10.1136\/bcr-2017-220186","type":"journal-article","created":{"date-parts":[[2017,10,20]],"date-time":"2017-10-20T10:40:14Z","timestamp":1508496014000},"page":"bcr-2017-220186","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Secondary aortoduodenal fistula and the unrecognised herald bleed"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-327X","authenticated-orcid":false,"given":"Francesc","family":"Sim\u00f3 Alari","sequence":"first","affiliation":[{"name":"General surgery, Centre Hospitalier de la val d\u2019Ariege, Foix, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Molina Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, Centre hospitalier du val d\u2019Ariege, Foix, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Israel","family":"Gutierrez","sequence":"additional","affiliation":[{"name":"General surgery, Centre Hospitalier de la val d\u2019Ariege, Foix, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A\u00efcha","family":"Ahamdanech-Idrissi","sequence":"additional","affiliation":[{"name":"Anesthesiology, Centre hospitalier du val d\u2019Ariege, Foix, Midi Pyr\u00e9n\u00e9es, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,10,20]]},"reference":[{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.1","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/0002-9610(75)90504-8","article-title":"Complications of surgery of the abdominal aorta","volume":"130","author":"Davis","year":"1975","journal-title":"Am J Surg"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.08.113"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2011.01.011"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.4","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2015.246"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2011.02.020"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.6","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4928"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.7","doi-asserted-by":"publisher","DOI":"10.1053\/svas.2001.27888"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.avsg.2016.03.028","article-title":"The importance of early diagnosis and treatment of patients with aortoenteric fistulas presenting with herald bleeds","volume":"36","author":"Deijen","year":"2016","journal-title":"Ann Vasc Surg"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-006-9062-7"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2007.02.009"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.11","doi-asserted-by":"crossref","first-page":"2468.e1","DOI":"10.1016\/j.ajem.2016.06.042","article-title":"When to expect aortoduodenal fistula as a cause of abdominal pain in ED patients","volume":"34","author":"Gesumaria","year":"2016","journal-title":"Am J Emerg Med"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.12","doi-asserted-by":"crossref","first-page":"271.e1","DOI":"10.1016\/j.avsg.2015.12.013","article-title":"Primary aortoduodenal fistula\u2014a case report and a review of the literature","volume":"34","author":"Varghese","year":"2016","journal-title":"Ann Vasc Surg"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.13","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200011000-00033"},{"key":"2025082700595415000_2017.oct20_1.bcr-2017-220186.14","unstructured":"Hirshberg A , Mattox KL . 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