Aortoesophageal fstula: A case misdiagnosed as esophagealpolyp

Abstract

Aortoesophageal fistula (AEF) is a rare and fatal disorder. It is also a life-threatening cause of massive upper gastrointestinal hemorrhage. Thoracic aortic aneurysm is the most common cause of AEF. Management of a patient with this disorder requires rapid diagnosis and immediate intervention, which is considered the best way to save the patient's life. We report a case of AEF misdiagnosed as esophageal polyp.

Primary aortoesophageal fistula: A rare but fatal cause of upper gastrointestinal bleeding

“…The first diagnostic tool for upper gastrointestinal bleeding is EGD, but its detection rate for AEF is low . The endoscopic findings include mild elevated or polypoid lesions with overlying clots or fibrins at the upper or middle esophagus . A pulsatile bulging lesion with or without adherent blood clots is rarely detected.…”

“…8 The endoscopic findings include mild elevated or polypoid lesions with overlying clots or fibrins at the upper or middle esophagus. 2,[13][14][15] A pulsatile bulging lesion with or without adherent blood clots is rarely detected. Therefore, a high index of suspicion is essential for a prompt diagnosis of AEF.…”

“…Aortoesophageal fistula (AEF) is a rare but fatal condition resulting in upper gastrointestinal bleeding, with a very high mortality rate if left untreated . AEF was first described by Dubreuil in 1818 .…”

Diagnosis of Aortic Aneurysm

“…These proportions would in fact increase with the use of ultrasound and computerized tomography. Even in such instances the common assumption is that the bleed is from either diverticuli, ulcers or varices (Jiao, Zong et al 2009;Senadhi, Brown et al 2010;Thomson, Gopinath et al 2009) and the aneurysm is usually considered an incidental finding. The pattern of bleeding from an aortoenteric fistula (AEF) is of interest.…”

“…Endoscopy is the cornerstone in the diagnostic work up for haematemesis. Nevertheless the detection of non bleeding erosions, ulcers, varices or polyps may be misleading (Jiao, Zong et al 2009) and negative endoscopy does not rule out an AEF as the length of the endoscope does not allow visualization of the distal duodenum where AEFs commonly occur (Brand, Sivak et al 1979). Although no single imaging modality demonstrates the condition with sufficient sensitivity and specificity, computed tomography (CT), owing to its widespread availability and high efficiency, has become the imaging modality of choice for evaluations in the emergency setting.…”