# The Herald Bleed—A Fortunate Endoscopic Diagnosis of an Aorto‐Duodenal Fistula Secondary to a Mycotic Aortic Aneurysm With Abscess Formation

## TL;DR

This paper describes a rare case of a life-threatening aorto-duodenal fistula diagnosed through endoscopy and highlights the importance of early detection and surgical management.

## Contribution

The paper presents a unique clinical case emphasizing the role of endoscopy in diagnosing aorto-duodenal fistulas.

## Key findings

- Aorto-duodenal fistulas are rare but cause severe gastrointestinal bleeding.
- Endoscopy can reveal a pulsatile clot or bleeding source, aiding diagnosis.
- Surgical intervention with multi-disciplinary support is the standard treatment.

## Abstract

Aorto‐duodenal fistula is a rare but catastrophic cause of gastrointestinal bleeding. A high index of suspicion is required for diagnosis. Reviewing previous imaging provides essential hints. A pulsatile clot or bleeding source can be seen on endoscopy. Management is surgical with multi‐disciplinary involvement. Unfortunately, mortality remains high.