Primary aortojejunal fistula manifested as herald gastrointestinal hemorrhage

Aortoenteric fistulas (AEFs) are a rare but fatal cause of massive, life-threatening gastrointestinal bleeding and require emergent intervention. The clinical signs of AEF are nonspecific and non-prevalent. The classic triad of AEF (abdominal pain, gastrointestinal hemorrhage, and a pulsatile abdominal mass) exhibit only in 23% of patients with AEF, which makes diagnosis of AEF difficult. Gastroduodenoscopy and abdominal computed tomography are the mainstay studies for AEF in the emergency setting. However, proving the existence of the AEF remains a difficult issue. AEF could be managed either by endovascular stent or open surgery. Herein, we report a case of primary aortojejunal fistula on which a successful surgical aortic reconstruction was performed.