An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm

Abstract

An aortoesophageal fistula, an abnormal anatomical communication between the aorta and the esophagus, is a rare cause of upper gastrointestinal bleeding. The mortality rate of patients with this condition is very high. A 77-year-old man, who had undergone endovascular aortic repair for a ruptured abdominal aortic aneurysm, developed melena. An upper gastrointestinal endoscopy was performed. This detected an esophageal ulcer, which had the potential to develop into an aortoesophageal fistula. Therefore, thoracic endovascular aortic repair was performed on the following day. Thereafter, the course was uneventful. We encountered a rare case of an esophageal ulcer associated with a thoracoabdominal aortic aneurysm before it developed into an aortoesophageal fistula.

Obscure Gastrointestinal Bleeding: A Diagnostic Dilemma?

“…The aim of this report was to emphasize the early diagnosis and management of all gastrointestinal bleedings in patients without a history of aortic aneurysm. 5,6 ACKNOWLEDGMENTS I am sincerely grateful to those who shared their truthful views on the article.…”

“…The aim of this report was to emphasize the early diagnosis and management of all gastrointestinal bleedings in patients without a history of aortic aneurysm. 5 , 6 …”

Primary Aortoesophageal Fistula Due to Esophageal Foreign Body: A Case Report

“…Because AEF is not a common cause of upper gastrointestinal hemorrhage, early diagnosis may be difficult ( Hwang & Cho, 2019 ). Although EGD is useful for the diagnosis of AEFs in patients with gastrointestinal hemorrhage, its diagnosis rate is low at around 25% ( Kayashima et al, 2019 ). Also, it should be noted that EGD can irritate blood clots, leading to severe re-hemorrhage ( Hwang & Cho, 2019 ).…”

“…In this case, the findings on EGD were highly suggestive for AEF and CTA was necessary for confirmation. The usefulness of CTA in this context was recently highlighted, with a diagnosis rate of 30%–61% ( Kayashima et al, 2019 ). The CTA scan revealed not only the classic AEF signs (i.e., ectopic gas adjacent to the aortic lumen and effacement of the periaortic fat plane), but also more characteristic and rare signs of direct extravasation of vascular contrast into the esophagus ( Monteiro, Martins, Martins da Cunha, Moleiro, & Patrício, 2020 ).…”

“…Also, EGD showed the esophageal submucosal tumor-like protrusion with an ulcerative lesion was completely healed. There are some reports of patients with AEF who have been successfully treated by interventional therapy alone ( Kayashima et al, 2019 ; Monteiro et al, 2020 ; Takeno et al, 2020 ).…”