A primary aortoduodenal fistula is a rare complication of atherosclerotic abdominal aortic aneurysm (AAA). The operative mortality is very high, because of lack of a precise preoperative diagnosis and contamination of the operative field. The authors report a case of a sixty-five-year-old man with aortoduodenal fistula. He was transferred to the emergency unit soon after cardiac arrest. An emergency laparotomy revealed a fistula between the third portion of the duodenum and an AAA. The authors successfully performed graft replacement for infrarenal AAA and primary repair for the penetrated wall of the duodenum.
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