Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tractwithout\nany previous vascular intervention and represents a rare but critical cause of repeated and massive gastrointestinal bleeding. Primary\nADF often occurs as a result of atherosclerotic aneurysm and infection, but ADF involving a normal-size aorta is rare; furthermore,\nADF related to radiation therapy is extremely rare. We present the case of a 56-year-old man with a history of bowel obstruction\ndue to radiation enteritis who was admitted with severe hematemesis and hemorrhagic shock. Gastroduodenal endoscopy and\ncontrast-enhanced computed tomography findings were unremarkable. Aortoduodenal fistula was suspected based on the diffuse\ncalcification of the abdominal aorta confined to the radiation field and the presence of an aortoduodenal communication on\nangiography. Endovascular repair with a stent graft seemed to be a safer option than open surgery andwas suited to the rapid control\nof bleeding from ADF because of the patients� unstable hemodynamic state and the presence of intestinal adhesions. The fistula\nwas successfully sealed by endovascular stent graft placement. Hematemesis did not recur postoperatively and anemia gradually\nimproved.The patient died from pneumonia 33 days later.
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