PMC6535879_01
Computed tomography of abdomen showing nonspecific findings, irregularity of the "aneurysmal sac" with a small amount of fluid around the sac.
CRIGM2019-6261526.001.jpg
PMC6535879_01_CRIGM2019-6261526.001.jpg
fig1
A CT abdomen with contrast done in the ED for abdominal pain showed nonspecific findings, i.e, irregularity of the "aneurysmal sac" with a small amount of fluid around the sac (see Figure 1) which was read by the radiologist as early postsurgical changes.
Computed tomography of abdomen showing tiny foci of air at the anterior aspect of the native aneurysm wrap just inferior to the location where the duodenum crosses.
CRIGM2019-6261526.002.jpg
PMC6535879_01_CRIGM2019-6261526.002.jpg
fig2
A CT abdomen and pelvis was performed which showed tiny foci of air at the anterior aspect of the native aneurysm wrap just inferior to the location where duodenum crosses (see Figure 2).
Push enteroscopy showing infected graft with purulent exudate extruding from an aortoduodenal fistula.
CRIGM2019-6261526.003.jpg
PMC6535879_01_CRIGM2019-6261526.003.jpg
fig3
At that time, a decision was made to perform push enteroscopy instead of simple EGD to evaluate second and third portion of duodenum which showed an aortoduodenal fistula with infected graft adherent to the bowel wall and extruding purulent exudate (see Figure 3).