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A primary aortoduodenal fistula is a life-threatening cause of haematemesis. Early recognition is essential for the prevention of complications and death. We describe the case of an 82-year-old man with acute haematemesis and melaena resulting from this condition. The diagnostic procedures included a gastroduodenoscopy and computed tomography angiography (CTA). The fistula was surgically removed, with neighbouring parts of the duodenum and aorta. The duodenum was closed by a simple anastomosis; the aorta by the introduction of a Dacron graft. The postoperative course was uneventful. Surgical intervention is the treatment of choice in patients with an aortoduodenal fistula.

In two adult patients, a 74-year-old woman and a 84-year-old man, who suffered from vague abdominal complaints, an intussusception was diagnosed by CT. Surgical resection of the affected bowel parts was successful. Intussusception is usually seen in children; in adults it is a rare condition. Adult patients mostly complain about vague abdominal pain only. Physical examination, laboratory investigations and plain abdominal X-rays often don't give any additional information. In such patients it is advised to perform CT of the abdomen at an early stage. CT may show a so-called 'target sign' which is characteristic of an intussusception. In addition it can provide information about the possible causes of the intussusception, most commonly a malignant tumour in adults. During laparotomy one should not attempt to reduce the intussusception because of the risk of tumour spill. In this clinical review, we present two adult patients with unexplained abdominal complaints due to intussusception, caused by malignancy.

A subfebrile girl with ascites.--A 16-year-old Ethiopian girl who had been living in the Netherlands for 4 years had ascites and echogenic spots in the abdomen. Laparoscopy revealed peritonitis tuberculosa.