Peptic ulcer-induced gastroaortic fistula: difficulty in making the diagnosis with selective angiography

We report a patient who had a gastroaortic fistula. This rare, potentially curable cause of torrential upper gastrointestinal hemorrhage is usually secondary to perforation of a gastric ulcer into the distal thoracic aorta. Hiatal hernia and previous gastroesophageal surgery (as in our patient) are important contributing factors in its genesis. It is essential to suspect this condition clinically so that the correct angiographic diagnosis can be made by biplane mid-stream thoracoabdominal aortography.