Survival After a Primary Ilio-Enteric Fistula and Cardiac Arrest in a Man Who Had Renal and Pancreatic Transplants

<b>Background:</b> Gastrointestinal bleeding (GIB) is a frequent emergency department (ED) presentation with rare but life-threatening causes, including arterio-enteric fistulas (AEF), which account for less than 1% of GIB cases. Ilio-enteric fistulas are even more rare but have similar morbidity and mortality. <b>Methods:</b> This case report describes a 51-year-old male with a history of type 2 diabetes mellitus, diabetic retinopathy, and pancreas–kidney transplantation who presented to the ED with a massive hemorrhage from an ilio-enteric fistula. Despite initial stability, the patient became hypotensive and deteriorated to pulseless electrical activity (PEA) arrest. Despite multiple arrests, he survived and was discharged to a rehabilitation facility. <b>Results:</b> AEFs, particularly iliac-enteric fistulas, are diagnostically challenging and often present with nonspecific symptoms. Diagnostic imaging, especially CT angiography, is crucial, although initial non-contrast CT may miss the diagnosis. Early consultation with vascular surgery is essential for managing these patients. <b>Conclusions:</b> This case underscores the need to consider AEF in the differential diagnosis of GIB, particularly in post-transplant patients, and highlights the importance of prompt intervention.