Tuberculous aorto-duodenal fistula: a rare cause of upper gastrointestinal bleeding

Chong VH, Telisinghe PU, Chong CF
Correspondence: Dr Chee Fui Chong, chong_chee_fui@hotmail.com

ABSTRACT
Aorto-enteric fistulas are rare and are associated with significant mortality. Infective causes usually occur within the setting of post-graft repair. Aorto-enteric fistula secondary to tuberculosis is extremely rare despite the high prevalence of this infection. Unfortunately, the diagnosis is often not suspected until surgery or at post-mortem. We report a case of an elderly Malay man presenting with massive gastrointestinal bleeding secondary to a tuberculous aorto-duodenal fistula in association with a saccular abdominal aortic aneurysm. This was successfully managed with an aortobifemoral graft repair and standard anti-tuberculous treatment for six months. A literature review of this rare condition is presented.

Keywords: aneurysm, fistula, gastrointestinal bleeding, tuberculosis
Singapore Med J 2010; 51(5): e85-e88