The Challenges of diagnosing and managing a ruptured abdominal aortic aneurysm with primary aortoduodenal fistula.

Primary aortoduodenal fistula is a rare and highly morbid complication of an abdominal aortic aneurism (AAA). Patient X presented with a ruptured AAA complicated by a primary aortoduodenal fistula in 2016 which was treated surgically but has since suffered from repeated admissions due to sepsis as a result of ongoing graft infections.  The diagnosis of aortoduodenal fistula is complicated with no imaging technique providing a definitive diagnosis meaning that maintaining clinical suspicion is important. There is a paucity of evidence regarding how to surgically approach the repair of an aortoduodenal fistula, although there is a shift towards multiple-step procedures in elective repair.