Amazing Case Report: Speedy Recognition of an Aortoesophageal Fistula

EC Oldfield, PJ Parekh. Clin Gastroenterol Hepatol 2021; 19: xxv. Open Access: Thoracic Aortic Erosion into the Esophagus With Aortoesophageal Fistula

The authors recognized a “visible thoracic aorta eroding into the esophagus through a large transmural defect (Figure A) and a nonbleeding aortoesophageal fistula (Figure B) directly superior to the erosion in the middle third of the esophagus. This 76 year old patient had a known thoracic aortic aneurysm.

My take: This is an amazing case report because the patient survived. It is very easy to imagine the circumstance of massive exsanguination. In all patients with known cardiac repair and disease, it is important to consider the possibility of an major vessel fistula into the esophagus in those presenting with significant hematemesis and to consider how this could be managed.

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