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Aorto-enteric fistula (AEF) is a rare condition caused by an abnormal connection between the aorta and the intestinal tract. This often results in fatal upper gastrointestinal bleeding (UGIB) with an untreated mortality rate of 100%.1 Of the two types of AEF, primary and secondary, the latter is more common and occurs following aortic surgery. The majority of primary AEF (PAEF) are due to spontaneous erosion of an abdominal aortic aneurysm (AAA) into the distal portion of the duodenum. These are extremely rare with an incidence of 0.07%.2 Other causes of PAEF include: infection, tumour, radiotherapy or foreign body ingestion. A high index of suspicion is required in symptomatic patients with a known AAA or recent abdominal aortic surgery to facilitate prompt diagnosis and intervention.
An elderly man known to have a 3.8 cm AAA presented to the surgical team with lower abdominal pain radiating to his back. His vital signs were …