The abdominal aortic aneurysm (AAA) is a vascular condition that commonly affects individuals over the age of 65, leading to complications such as rupture, thrombosis, and embolization that can result in significant morbidity and mortality. Aorto-enteric fistula (AEF), a rare but life-threatening complication of abdominal aortic aneurysms, occurs when there is communication between the aneurysm and adjacent bowel loops. A 63-year-old man presented to the emergency department (ED) with severe abdominal pain, nausea, vomiting, and dark, tarry stools. Prior to his current presentation, the patient sought medical care from several primary care centers for vague abdominal pain that was diagnosed as dyspepsia, and he was prescribed omeprazole. During the current presentation, the patient had hemodynamic instability and a diffusely tender abdomen. Subsequently, a computed tomography (CT) scan revealed an abdominal aortic aneurysm with AEF. Although the patient underwent exploratory laparotomy, he suffered cardiac arrest and ultimately died in the operating room. This case underscores the importance of early recognition and management of AEF, which is crucial for improving patient outcomes.