A woman with hemorrhagic shock

BACKGROUND: Acute upper gastrointestinal bleeding may be a life-threatening condition that calls for immediate diagnosis and action. MATERIAL AND METHODS: We present an 82-year-old female patient with haematemesis, who during the first few minutes after admission developed haemorrhagic shock. At emergency laparotomy, a profuse bleeding in the duodenum was found. During surgery the patient developed cardiovascular collapse and died. The patient had a previous diagnosis of duodenal ulcer. She was, furthermore, diagnosed with an abdominal aortic aneurysm developing at the cranial anastomosis of an aorto-bifemoral bypass performed seventeen years earlier. An autopsy was performed and confirmed the clinical suspicion of an aorto-duodenal fistula. RESULTS AND INTERPRETATION: An aorto-enteric fistula represents a direct communication between the aorta and the intestinal lumen; it can be primary or secondary. Secondary aorto-enteric fistulae are complications of reconstructive procedures on the abdominal aorta. Based on register data, approximately three patients with this condition could be expected per year in Norway (incidence 1.6 %). Patients with severe gastric-intestinal bleeding and previous aortic reconstruction represent an identifiable group that should be referred directly to hospitals with competence in vascular surgery.