Primary Aortoesophageal Fistula Presenting as Upper Gastrointestinal Bleed

Abstract

Aortoenteric fistula is a rare condition that can be primary or secondary. The primary type is less common than the secondary. The secondary aortoenteric fistula is an uncommon fatal complication after reconstructive surgery for an aortic aneurysm or other aortic diseases. Here we present a case of a 59-yearold man who presented to our emergency department with sudden onset of massive hematemesis. Imaging studies were done and the patient was diagnosed to have aortoesophageal fistula. Upper gastrointestinal endoscopy showed an intraluminal bulge in the posterior wall of the esophagus with an ulcer and hematoma. The patient was planned for emergency surgical intervention, but the patient had recurrent bouts of hematemesis and, unfortunately, expired. Hence patients presenting with massive hematemesis, aortoenteric fistula can be the underlying cause, and all surgeons should be aware of such conditions and the need for emergent surgical intervention.

Chicken Bone Ingestion Leads to Aortoesophageal Fistula With Catastrophic Bleeding

“…Herald bleeding often does not result from an actual aortoenteric communication but from focal necrosis and mucosal ulceration. 7,8 In AEF, the sentinel bleeding may be minor initially due to the formation of thrombus plugging the fistula as a result of hypotension. However, the plug may be dislodged and extruded out of the canal after the patient becomes normotensive with resuscitation leading to further bleeding and can result in exsanguination.…”