Aortoenteric Fistula-A Bomb in the Emergency Department: Suspect and do not Wait

Aortoenteric fistulas (AEF) are uncommon but fatal complications during aortic surgery that can cause heavy gastrointestinal bleeding (GIB). We present a patient who underwent aortic surgery and developed GIB that led to hemorrhagic shock. A 66-year-old man was transferred to our emergency department (ED) because of deterioration in his general condition. On arrival at the ED, he was confused, pale, cooperative, cold, and sweaty. His blood pressure was 70/40 mmHg and pulse rate, 130/min. Plenty of fresh blood was seen in the nasogastric tube. We learned from patient’s family that he had undergone aortic surgery. The surgical team was notified regarding the possibility of an AEF. The patient was transferred to the operating room immediately without any imaging tests being performed. In patients with massive GIB who had undergone aortic surgery, AEF should be considered. When considering the diagnosis of AEF, surgical intervention should be performed as soon as possible before performing diagnostic tests. (Eurasian J Emerg Med 2015; 14: 145-7)