METHODS: A literature review highlighted aetiology which included gallstone erosion, carcinoma of the pancreas and duodenal diverticulum. With written consent, we present the case of a 59 year old female, brought to the hospital following an episode of haematemesis and later found to have an AEF, secondary to metastatic retroperitoneal carcinoma - an extremely rare aetiology.
CONCLUSIONS: There is far less literature on primary AEF when compared to secondary AEF. Furthermore, there is a variation in aetiology. Identifying the presence of a \'herald\' bleed appears to be significant.
CONCLUSIONS: Aorto-enteric fistulae must always be considered as a potential diagnosis in the setting of an acute upper GI haemorrhage with no apparent cause.