Rao Khalid Mehmood, Abid Mushtaq, David R Andrew, George Allan Miller.
Clinical presentation of a missed primary aorto-enteric fistula.
J Pak Med Assoc Jan ;57(12):616-8.

Primary aortoenteric fistula is a rare but potentially fatal cause of gastrointestinal bleeding. The diagnosis of primary aortoenteric fistula is difficult to make and is usually accompanied by a very high level of clinical suspicion. In the context of a known abdominal aortic aneurysm it is reasonable to have a high index of clinical suspicion of aortoenteric fistula. It should be included in the differential diagnosis with low back pain and a palpable midline abdominal mass in a haemodynamically stable patient. We present a case of a 59 year old man with no past history of abdominal aortic aneurysm presented with lower back and periumblical pain. Initial misdiagnosis led to a delay in treatment and the patient succumbed to the illness.

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