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Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding
  1. Sylvester Paulasir,
  2. Rhami Khorfan,
  3. Christina Harsant,
  4. Harry Linne Anderson III
  1. Department of Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Harry Linne Anderson III, harry.anderson{at}


A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident.

  • General surgery
  • Gastrointestinal surgery
  • GI bleeding
  • Vascular surgery

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  • Contributors SP wrote the first draft of the manuscript. RK formatted the images and table. CH and HLA supervised, edited and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained from next of kin.

  • Provenance and peer review Not commissioned; externally peer reviewed.