Primary aortoesophageal fistula: a rare cause of acute upper gastrointestinal bleeding

Abstract

Acute upper gastrointestinal bleeding is a potentially life-threatening emergency, especially in the elderly. This condition accounts for approximately 1% of all emergency room admissions. Among the causes of such bleeding is aortoesophageal fistula, a dreaded but apparently rare condition, first recognized in 1818. The great majority of cases are of primary aortoesophageal fistula, caused by atheromatous aortic aneurysms or, less frequently, by penetrating aortic ulcer. The clinical presentation of aortoesophageal fistula is typically characterized by the so-called Chiari’s triad, consisting of thoracic pain followed by herald bleeding, a variable, short symptom-free interval, and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospital mortality rate being 60%. Conservative treatment does not prolong survival, and the in-hospital mortality rate is 40% for patients submitted to conventional surgical treatment. Here, we report the case of a 93-year-old woman who presented to the emergency room with a history of hematemesis. The patient was first submitted to upper gastrointestinal endoscopy, the findings of which were suggestive of aortoesophageal fistula. The diagnosis was confirmed by multidetector computed tomography of the chest. Surgery was indicated. However, on the way to the operating room, the patient presented with massive bleeding and went into cardiac arrest, which resulted in her death.

Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma

“…The diagnosis of mycotic aortic aneurysms can be greatly challenging due to the common nonspecific symptoms including the presence of fever and general malaise. AEF may present with the classical clinical symptoms known as Chiari triad which is characterised by central chest pain, dysphagia, and sentinel haemorrhage followed by exsanguinating hematemesis [ 6 ]. The imaging modality of choice for detection of AEF is multislice CT angiography, with 3D reconstructions being demonstrated in this case.…”

Case Report: Successful Repair of Primary Aortoesophageal Fistula With an Endovascular Stent Graft and an Esophageal Stent

“…Multiple parietal ulcers were observed on the descending aorta ( Figure 4 ), which resulted from the ulceration of a previous atherosclerotic plaque. PAUs penetrate the aortic wall from the internal elastic lamina to the arterial media; the hematoma is initially contained by the tunica adventitia, leading to a pseudoaneurysm formation ( 10 ). Therefore, we can see a hematoma of 40 × 60 mm in the CTA due to active contrast media extravasation.…”

Two unique cases of primary aortoenteric fistula following a small aneurysm and penetrating ulcer of the abdominal aorta

“…Although there are various reports of thoracic PAUs associated with a primary aortoesophageal fistula, our second case is remarkable as it is the first report of an abdominal PAU causing a PAEF in the English literature. [10][11][12][13] Vujcic et al recently reported a case of an aorto-appendicular fistula which may be related to an abdominal PAU; however, the authors suggested that undetected chronic appendicitis was the actual cause of the degradation of the aortic wall. 14 In our case, a focal penetrating ulcerative lesion of the infrarenal abdominal aorta evolved from an atherosclerotic plaque to a contained rupture inducing a PAEF.…”