Secondary aorto-enteric fistula: a case report and review of literature.

Aorto-enteric fistula (AEF) is an uncommon but potentially fatal condition that is important to identify early because early diagnosis and aggressive management can reduce mortality. We report the case of a 73-year-old man with a history of aorto-bifemoral bypass grafting who was admitted for investigation of tiredness and lethargy. He passed melaena on the day of admission with an associated drop in haemoglobin. Initial upper gastrointestinal endoscopy revealed no significant abnormality. Later in the admission he again passed melaena, this time in large amounts. A repeat endoscopy identified a defect in the duodenal mucosa with visible Dacron graft. The patient went on to suffer another large bleed from which he could not be resuscitated. Our report highlights a fatal manifestation of aorto-enteric fistula, and reviews the associated literature.