Primary Salmonella-associated Aortoenteric Fistula Presenting with Massive Hematemesis: A Case Report

Aim: Primary aortoenteric fistula (AEF) is a rare but life-threatening cause of massive gastrointestinal bleeding, characterized by an abnormal communication between the abdominal aorta and the gastrointestinal tract. Salmonella-associated AEF represents a small subset (1–2%) of cases, typically arising from infectious arteritis leading to aortic wall necrosis and aneurysm formation. Case Presentation: We report the case of a 57-year-old man with a history of Salmonella arteritis and a known abdominal aortic aneurysm who presented with sudden massive hematemesis. Initial bedside ultrasonography suggested aneurysm rupture, and subsequent thoracoabdominal computed tomography (CT) angiography confirmed a 6 cm aneurysm with fistulization to the jejunum. Despite aggressive resuscitation, including intubation, massive transfusion, and cardiopulmonary resuscitation, achieving temporary return of spontaneous circulation, the patient’s hemodynamic instability precluded surgical repair. The patient ultimately succumbed to recurrent cardiac arreste. Conclusion: This case highlights the diagnostic challenges and high mortality associated with Salmonella-related primary AEF. Early consideration of AEF in patients with vascular infections presenting with gastrointestinal bleeding is critical. Contrast-enhanced CT angiography remains the gold standard for diagnosis, enabling the timely identification of fistulization and guiding management. Multidisciplinary approaches that incorporate infection control, hemodynamic stabilization, and surgical intervention are essential for improving outcomes in this rare but fatal condition.