Salmonella Aortitis Causing Primary Aortoenteric Fistula

A 70-year-old male presented with overt upper gastrointestinal bleeding in the forms of hematemesis and melena. He was evaluated and detected to have an infrarenal abdominal aortic aneurysm (AAA) with the involvement of duodenum and presence of air within the aneurysmal sac hematoma suggestive of primary aortoenteric fistula (PAEF). He underwent emergency endo-aneurysmorraphy and debridement of the aortic wall. The infected aneurysmal wall grew Salmonella Typhi. Post-surgery, he was treated with culture-specific antibiotics for 3 months and had an uneventful recovery. Infected AAA secondary to Salmonella Typhi infection presenting as primary aortoenteric fistula (AEF) is a rare entity. Treatment of this entity is early surgical intervention followed by long-term culture-specific antibiotics.