Aortogastric fistula is a rare but often fatal condition, typically presenting as acute gastrointestinal bleeding. Owing to its rarity the diagnosis is commonly missed or delayed. Early diagnosis may be achieved by radiological or endoscopic means, however prompt surgical evaluation and repair is essential for successful treatment. In many cases mortality remains high despite intervention, hence a high index of suspicion is required for early diagnosis and treatment. Aortogastric fistula following fundoplication has been reported in the literature up to 5 years post-surgery, with multiple factors suggested to account for the development of such fistulae. This presentation reports the case of a 54 year old female who presented to hospital with haematemesis, anaemia and hypoptension and a background of prior fundoplication surgery. Despite aggressive fluid resuscitation and monitoring in a critical care setting, she passed away prior to stabilisation for endoscopic evaluation. A post mortem diagnosis of aortogastric fistula was made. Clinicians should remain wary of this potentially lethal diagnosis as a cause of haematemesis and haemodynamic instability in the setting of previous fundoplication surgery.