Gastrocardiac fistula is a rare, typically fatal, diagnosis which has been reported infrequently in post-esophagectomy patients and, to a much lesser extent, patients with history of Roux-en-Y gastric bypass. This case describes a patient with a history of an eroded adjustable gastric band and subsequent removal with conversion to Roux-en-Y gastric bypass that initially presented with an upper gastrointestinal bleed. She was found to have a transdiaphragmatic fistula between the gastric lumen and left ventricle.