An uncommon cause of gastrointestinal bleeding: the calm before the storm.

Secondary aortoenteric fistula is an uncommon but serious cause of upper gastrointestinal bleeding. There should always be a high degree of suspicion for this condition when there is history of aortic reconstruction surgery, especially if the aortic graft is infected. Typically a warning mild gastrointestinal bleeding precedes a catastrophic hemorrhagic shock. The prognosis is poor and the treatment is surgical. In this case the authors report an aortoenteric fistula leading to hemorrhagic shock and death in a 69-year-old man with a bilateral aortoiliac graft. Computed tomography angiography did not reveal the etiology and only endoscopy showed the aortoenteric fistula. A protracted diagnosis contributed to the fatal outcome in this case, even though advanced imaging modalities were used.