Aortoenteric fistula causing massive bleeding

Objective: Aortoenteric fistula (AEF) is a rare but potentially lethal condition. We present a typical case report and give a brief overview of diagnosis and treatment. Patient: An 83-year-old man presenting with recurrent haematemesis, melaena, and collapse four years after aortic surgery. Measurement and results: Gastroscopy showed a focal defect in the duodenum, and angiography confirmed the presence of an actively bleeding AEF. An endovascular graft was deployed (endovascular aortic repair, EVAR) and activated factor seven was administered, which controlled the bleeding. The patient subsequently died of multi-organ dysfunction syndrome. Conclusion: AEF is a life-threatening condition. A high index of suspicion, urgent imaging, and treatment are essential. EVAR can be used as a bridge to conventional surgical treatment, or as definitive treatment in patients not suitable for surgery. Activated factor VII might be used as an adjunct to achieve haemostasis.