A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

Akın, Mete; Yalçınkaya, Tolga; Alkan, Erhan; Arslan, Gökhan; Tuna, Yaşar; Yıldırım, Bülent

doi:10.5455/medarh.2016.70.79-81

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…Computer tomography is an examination of choice in patients who had undergone TEVAR in case of suspected complications. In patients with AEF, CT angiogram shows the presence of gas in aneurysm sac [2,4,5], thickening of esophagus [6], and new nonhomogenous masses between aorta and esophagus [2,7]. In our cases, the presence of gas in aneurysm sac (Patient 1 and 2), as well as thickened esophagus and defect in the aortic wall (Patient 1) were detected.…”

Section: Discussionsupporting

confidence: 51%

“…The time to develop AEF after TEVAR varies. Analyzing literature, we can conclude that AEF develops within 1 to 16 months after the endovascular procedure [2][3][4][5][6][7][8]. Nevertheless, patient 1 developed AEF much later -5 years after TEVAR.…”

Section: Discussionmentioning

confidence: 86%

“…Esophagus x-ray examination with contrast can confirm or exclude the presence of AEF (as per case 1 which confirmed preliminary diagnosis based on CT). EGD not always identifies the place and cause of bleeding [5,6]. However, in combination with CT scans, it significantly increases the probability of confirmation or exclusion of AEF [2][3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…EGD not always identifies the place and cause of bleeding [5,6]. However, in combination with CT scans, it significantly increases the probability of confirmation or exclusion of AEF [2][3][4][5][6][7][8]. Therefore, it seems that EGD should be the examination of choice when AEF is suspected, despite the risk of additional transmission of bacteria from the esophagus to the aneurysmal sac.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AEF after TEVAR usually die before the beginning of treatment due to the presence of bleeding and general bad condition [3,6,8]. In these cases, the only option is open surgery with removal of the stent graft and replacement of the aorta with a vascular prosthesis.…”

Section: Discussionmentioning

confidence: 99%

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Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

et al. 2020

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Thoracic endovascular aortic repair (TEVAR) is a method of choice in the treatment of thoracic aorta aneurysms and dissections. In case of a thoracoabdominal aneurysm, endovascular treatment is also being chosen more often, especially in patients with multimorbidity. Despite better results and less invasiveness in comparison to classic open surgery, endovascular treatment is also associated with complications. One of the rarer and usually fatal complications are aortoesophageal fistula (AEF). We present two cases, in which TEVAR complication was AEF. Case 1 was an 87-year-old woman with a history of TEVAR 5 years earlier, who presented increased inflammation parameters, massive gastrointestinal bleeding, and progressive anemia. Case 2 was a 66-year-old woman with a history of TEVAR 6 months earlier, who on admission presented medium increased inflammatory markers and anemia. None of the patients was qualified for surgical treatment. Both patient 1 and patient 2 died during hospitalization. Diagnostic imaging plays a key role in the diagnosis of AEF. CT angiography performed in patients with AEF can show the presence of gas in the sac of aneurysm as a result of infection, a defect in the aortic wall, or thickened esophagus with fluid level. CT angiography of the aorta combined with esophagogastroduodenoscopy (EGD) and contrast-enhanced X-ray examination of the gastrointestinal tract, enables to confirm or exclude the diagnosis of AEF. Atypical clinical feature and increased parameters of inflammation in patients with the history of TEVAR should always suggest the presence of AEF.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

et al. 2020

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Aortoesophageal fistula complicated by mycotic aneurysm secondary to endoscopic procedures: A case report

Hafezeftekhari,

Khoroushi,

Bozorgi

2023

Clinical Case Reports

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Gastrointestinal bleeding is one of the leading causes of hospitalization. The most common causes of upper gastrointestinal bleeding are gastric ulcer, gastritis, esophageal varices, and Mallory-Weiss syndrome. However, there are also less common causes that often receive little attention in the emergency department, such as aortoesophageal fistula (AEF). 1 AEF is a rare but life-threatening cause of upper gastrointestinal bleeding, with a mortality rate of 77% with appropriate treatment and 100% without treatment. 2 AEF can be primary or secondary. The primary type is caused by various factors, including thoracic aortic aneurysm, foreign body, esophageal cancers, and radiotherapy. The secondary type is usually caused by complications of surgeries performed on the aorta or esophagus, and can also occur as a result of the implantation of surgical grafts. 3 Clinical symptoms of AEF can range from asymptomatic patients to very critical patients. Classic patients present with the Chiari triad of central chest pain, sentinel arterial bleeding, and fatal bleeding after an asymptomatic period.

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Upper gastrointestinal bleeding from primary aortoesophageal fistula in a patient with aneurism of the thoracoabdominal aorta: Case report and literature review

Ristovska,

Krstevski,

Andov

et al. 2024

Clinical Case Reports

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Key Clinical MessageUpper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option.AbstractWe present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment.

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A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula

Cited by 12 publications

References 15 publications

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Aortoesophageal fistula as a complication of thoracic aorta stent graft implantation: two cases and literature review

Aortoesophageal fistula complicated by mycotic aneurysm secondary to endoscopic procedures: A case report

Upper gastrointestinal bleeding from primary aortoesophageal fistula in a patient with aneurism of the thoracoabdominal aorta: Case report and literature review

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