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Figure 1 shows a dacron graft reaching several centimetres into the third part of the duodenum far beyond the papilla, surrounded by a sanguineous and fibrinous ulcer of the bowel wall. The patient had a secondary aortoenteric fistula, a late onset complication following reconstructive aortic surgery with an incidence ranging from 1% to 2%.1 The pathogenesis of secondary aortoenteric fistulas following aortic grafting often involves chronic low grade infection of the graft and perigraft …

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