SESSION TITLE: Surgery Case Report Posters
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Aortoesophageal fistula (AEF) is a rare and fatal disorder. We report a case of massive upper gastrointestinal hemorrhage in a patient with aortoesophageal fistula due to a descending aortic pseudoaneurysm.
CASE PRESENTATION: A 88-year-old women presented with an episode of vomiting bright red blood associated with nausea,. Se had no chest pain, cough or shortness of breath. The patient had a history of ascending aortic dissection with repair four years prior. Initial findings included hypotension (99/43), tachycardia (heart rate 114) .Physical exam revealed a soft non tender abdomen with haeme positive stool, Hemoglobin was 8.8 g/dL on admission. Chest CT (Figure 1) revealed a pseudoaneurysm arising from the ascending aorta, measuring 6.5 x 3.2 x 4.3 cm, which compresses and displaces the trachea toward the right and also causing dilation of the upper thoracic esophagus measuring up to 2.2 cm. Esophagoscopy (Figure 2) revealed large pulsating mass occupying probably half the lumen of the esophagus in the mid portion with some blood in the esophagus . Cardiothoracic surgery were consulted to take the patient to the operating theatre but family decided to continue with palliative care due the high risk nature of the procedure, she passed away on her second hospital day.
DISCUSSION: Arterial-esophageal fistula represents an uncommon, often catastrophic complication of either esophageal or arterial diseases (1). Thoracic aortic pseudoaneurysm is one of the causes of AEF, the aetiology of which consists of injury. The classical Chiari triad of aortoesophageal syndrome is dysphagia, mid-thoracic pain and sentinel minor hematemesis followed by exsanguination (2). Computed tomographic angiography is an accurate and non-invasive method for diagnosing AEF, Endoscopy is usually needed to exclude other causes of bleeding. Once identified; surgical repair is mandatory which includes thoracic aorta replacement with a synthetic graft. Primary repair and esophageal resection should also be done to avoid the complications of infection (3).
CONCLUSIONS: Aortoesophageal fistula (AEF) is an uncommon but life threatening cause of upper gastrointestinal haemorrhage. Without emergent surgical intervention; AEFs are always fatal.
Reference #1: B S Edwards; W D Edwards; D C Connolly; J E Edwards . Arterial-esophageal fistulae developing in patients with anomalies of the aortic arch system. Chest. 1984; 86(5):732-735. doi:10.1378/chest.86.5.732
Reference #2: Lawrence Tose; Robert T. Potter; Eugene G. Laforet. Aortic-Esophageal Fistula: Attempted Surgical Repair. Chest. 1962; 41(6):680-684. doi:10.1378/chest.41.6.680
Reference #3: : Yue Jiao, Ye Zong, Zhong-Lin Yu, et al. Aortoesophageal fistula: A case misdiagnosed as esophageal polyp. World J Gastroenterol 2009 December 21; 15(47): 6007-6009. doi:10.3748/wjg.15.6007
DISCLOSURE: The following authors have nothing to disclose: Murad Abdelsalam, Kevin Westra, Mubashir Mumtaz, William Bachinsky
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