Introduction: Upper gastrointestinal bleeding is common and may be mild to potentially life threatening. The commonest
cause is ulceration and variceal bleeding, however there are many other less common causes. Endoscopy is the mainstay of
diagnosis and also often allows for concurrent management. In some cases though, endoscopy alone may not be sufficient to
identify the underlying etiology.
Case Presentation: The case describes a 70-year-old male who developed upper gastrointestinal bleeding 13 days after cholecystectomy
complicated by bile leak requiring ERCP and stenting. His background was significant for open AAA repair complicated by chronic graft
infection. Initial management was based on a presumed diagnosis of stress ulceration or postsphincterotomy bleed with endoscopy showing
friability of the periampullary mucosa. However based on CT findings and clinical history the patient was diagnosed with secondary
aortoenteric fistula. He underwent surgical bypass and repair.
Discussion: Aortoenteric fistula is a rare cause of upper gastrointestinal bleeding. It may present with a herald bleed or with
massive haemorrhage. Diagnosis may be difficult with the diagnosis often not able to be made by endoscopy. High index of
suspicion based on patient history is critical, as well as CT findings. Initial management is resuscitative followed by extra-anatomical
bypass, resection of the affected graft and repair of the affected small bowel.
Conclusion: Upper gastrointestinal bleeding is common, while aortoenteric fistula is an uncommon but potentially life-threatening
cause. Early diagnosis and management is crucial and requires a high index of suspicion as well CT findings and endoscopy.
Abdominal aortic aneurysm; Aortoenteric fistula; Case report; CT findings; Upper gastrointestinal bleeding
AAA: Abdominal Aortic Aneurysm; ERCP: Endoscopic Retrograde Cholangiopancreatography; CT: Computed Tomography