Background: Coarctation of the aorta is a common congenital heart lesion with a known complication of collateral vessel formation if left untreated.
Objective: To alert pediatric emergency physicians of a rare and life-threatening presentation of previously undiagnosed congenital heart disease in the adolescent.
Case: We discuss the case of a 15-year-old boy who presented with hypertension and massive upper GI bleed due to aortoenteric fistula formation associated with undiagnosed coarctation of the aorta. There are no other reports of a similar presentation in the literature.