Primary aortoenteric fistula is a rare clinical entity that often has a fatal outcome. It usually arises from an atherosclerotic aneurysm, and induction by abdominal infection is extremely rare. This report presents the case of 54-year-old man with a history of aortic arch replacement and elephant trunk stent implantation 6 years earlier for Stanford type A aortic dissection. At 11 months before his current presentation, he underwent enteroscopy, during which gastrointestinal perforation occurred. Since then, he had experienced episodes of syncope and hemorrhage. Finally, a fistula was found on imaging. Endovascular treatment and digestive tract repair were accomplished. At 13-month follow-up, he had not had a recurrence of hematochezia or fever.
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