Primary aorto-esophageal fistula: Great masquerader of esophageal variceal bleeding

Abstract

Aorto-esophageal fistula is a rare cause of upper gastrointestinal bleeding. Thoracic aneurysm, the most common cause of this condition, will slowly increase over time and can erode the wall of the aorta creating a fistula and leading to torrential bleeding. High clinical suspicion is required for timely diagnosis as common investigations routinely done for gastrointestinal (GI) bleeding, including esophagogastroduodenoscopy, fails to detect most cases. The classical triad of midthoracic pain, herald bleeding and fatal hematemesis described in this condition is seen in only one-third of cases. Physician should be wary of this condition, especially in elderly patients with uncontrolled GI bleeding and who are also at risk of thoracic aneurysm. Computed tomography angiogram detects most cases and emergent endovascular repair with stents controls the initial bleeding. Later, both the aorta and the esophagus are repaired and reconstructed in staged procedures.

Acute upper gastrointestinal bleeding caused by esophageal right bronchial artery fistula: A case report

“…Arterioesophageal fistulas (AEFs) are pathological communications between an arterial system and the esophagus, which may lead to exsanguination from massive UGIB if not recognized promptly. They develop most commonly due to aortic fistulization caused by foreign bodies, aortic aneurysm, or esophageal neoplasms[ 4 - 6 ]. Nonaortic AEFs have been less frequently reported, with the bronchial artery being the most commonly involved vessel.…”

Esophageal emergencies: another important cause of acute chest pain

“…Transmural injury to the esophagus or prolonged inflammation of the mediastinum can have lasting effects, and due to the lack of serosa, the esophagus can be vulnerable to forming various fistulas with surrounding structures including the trachea or bronchus, pleura, pericardium, and rarely the aorta (Figs. 4 and 5 ) [ 35 , 36 ]. The most common of these is development of a tracheoesophageal fistula (TEF), an abnormal connection typically between the anterior wall of the esophagus and posterior wall of the airway.…”

An Esophageal Ulcer Associated with a Thoracoabdominal Aortic Aneurysm

“…An aortoenteric fistula (AEF), an abnormal anatomical communication between the aorta and digestive tract, is a rare cause of upper gastrointestinal bleeding [1]. There are 2 types of AEFs: primary AEFs (PAEFs) and secondary AEFs (SAEFs) [2]. SAEFs occur due to bacterial infection of artificial blood vessels after artificial revascularization surgery, while PAEFs are caused by other factors.…”