Aortoenteric fistula: a catastrophe waiting to happen

Presented is the case of a patient with recurrent massive upper gastrointestinal hemorrhage. Evaluation during initial hospitalization revealed no definite etiology. During his second hospitalization, he underwent exploratory laparotomy, and an abdominal aortic aneurysm with fistulization into the duodenum was identified. During surgery the patient suffered a cardiopulmonary arrest and could not be resuscitated. This case exemplifies some of the important clinical features that may suggest the diagnosis, including presence of a pulsatile abdominal mass, a peculiarly intermittent or obscure source of bleeding, and the concomitant complaint of back pain and gastrointestinal bleeding.