Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

Abstract

Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

Foreign Body: Uncommon Cause of a Catastrophic Upper GI Bleeding: a Case Report

“…Local invasion, erosion of the pharynx, or esophageal adenocarcinoma usually led to massive hematemesis due to vessel-esophageal stula. Esophageal foreign bodies may cause a similar complication and, in most cases, lead to sudden death, which should be promptly treated before developing massive uncontrollable hemorrhage (1).…”

Successful management of an aorto-gastric fistula occurring 15 years after oesophagectomy with covered aortic stent graft placement followed by open surgery

“…Most previous cases documented the development of fistulae at suture or anastomosis lines penetrating or perforating into the aorta [1–3]. This is usually seen within weeks of the procedure and likely as a complication of acute infection or leak [1, 3, 4].…”

“…This is usually seen within weeks of the procedure and likely as a complication of acute infection or leak [1, 3, 4]. …”