Primary aortoduodenal fistula caused by severe atherosclerosis, not by aneurysm.

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Primary aortoduodenal fistula is an uncommon cause of massive upper gastrointestinal hemorrhage usually due to pressure erosion of an abdominal aortic aneurysm into the third portion of the duodenum. This report describes a case of a 59-year-old man who died of massive gastrointestinal hemorrhage due to a primary aortoduodenal fistula. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, with adventitial chronic inflammation and foreign body reaction against atheromatous plaque, and not from an aneurysm. We were unable to identify any other reports of aortoduodenal fistulas developing spontaneously in the absence of aneurysmal disease of the aorta.







David Michael Gallagher

Professor of Medicine

I am currently the Chief Medical Officer at Duke University Hospital. As CMO I am a member of the senior leadership team that positively impacts the strategies, goals, and objectives at our hospital. I also help support Duke Clinical Automated Laboratories in a clinical consultant role. I am a Professor of Medicine at Duke University. My faculty career track is as a Clinician Leader – Administrator with an emphasis on Clinical Practice Advancement. I have 25+ years of physician leadership experience with previous roles as Chief of Duke Hospital Medicine Programs and Associate CMO of Duke University Hospital. As a clinically active hospitalist, I actively teach learners as an attending physician for Duke Hospital General Medicine Teaching Services caring for patients at DUH and other venues. I am board certified by the American Board of Internal Medicine with a Focused Practice in Hospital Medicine, current in that board’s Maintenance of Certification Program, and have achieved the designation and recognition as a Senior Fellow in Hospital Medicine through the Society of Hospital Medicine. The themes of my scholarly output include readmissions reduction, venous thromboembolism risk in hospitalized older adults, physical activity in hospitalized older adults, mentorship programs for hospitalists, quality improvement teaching to residents, and hospitalist workflow improvements.

My Twitter handle is @DGallagherMD

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