A Rare Cause of Haematemesis; a Primary Aorto-Esophageal Fistula: Case Report and Review of Literature

Aorto-Esophageal fistula is a rare condition, causes excessive bleeding from the upper gastrointestinal tract and is associated with a high mortality. This case report demonstrates the presentation of a 63-year old female with a primary aorto-esophageal fistula, due to a ruptured thoracic aneurysm. She first presented with a sentinel haemorrhage, followed by a new bleeding several hours later. An earlier performed upper gastrointestinal endoscopy elsewhere, because of dysphasia, already mentioned an impression from a non pulsing compressive swelling. No further analysis was performed. At current presentation, she was hemodynamically instable, with mild haematemesis. After stabilising she was admitted to the Intensive Care unit; however, haematemesis worsened. An immediate Computed Tomography (CT) scan showed an Aorto-Esophageal Fistula (AEF), due to a ruptured thoracic aortic aneurysm. Emergent surgical treatment consisted of endovascular stent-graft of the thoracic aorta and a total thoracic esophagectomy combined with immediate esophago-gastrostomy. Unfortunately, the subsequent multi-organ failure was fatal. A critical view to the surgical approach is given, combined with a review of diagnostic and therapeutic options in aorto-esophageal fistulae.