Aorto-esophageal fistula is a rare cause of upper gastrointestinal bleeding. Thoracic aneurysm, the most common cause of this condition, will slowly increase over time and can erode the wall of the aorta creating a fistula and leading to torrential bleeding. High clinical suspicion is required for timely diagnosis as common investigations routinely done for gastrointestinal (GI) bleeding, including esophagogastroduodenoscopy, fails to detect most cases. The classical triad of midthoracic pain, herald bleeding and fatal hematemesis described in this condition is seen in only one-third of cases. Physician should be wary of this condition, especially in elderly patients with uncontrolled GI bleeding and who are also at risk of thoracic aneurysm. Computed tomography angiogram detects most cases and emergent endovascular repair with stents controls the initial bleeding. Later, both the aorta and the esophagus are repaired and reconstructed in staged procedures.
Straube S, Tramèr MR, Moore RA, Derry S, McQuay HJ. Mortality with upper gastrointestinal bleeding and perforation: Effects of time and NSAID use. BMC Gastroenterol 2009;9:41.
Feinstein LB, Holman RC, Yorita Christensen KL, Steiner CA, Swerdlow DL. Trends in hospitalizations for peptic ulcer disease, United States, 1998-2005. Emerg Infect Dis 2010;16:1410-8.
Göbölös L, Miskolczi S, Pousios D, Tsang GM, Livesey SA, Barlow CW, et al. Management options for aorto-oesophageal fistula: case histories and review of the literature. Perfusion 2013;28:286-90.
Amin S, Luketich J, Wald A. Aortoesophageal fistula: case report and review of the literature. Dig Dis Sci 1998;43:1665-71.
Chak A, Cooper GS, Lloyd LE, Kolz CS, Barnhart BA, Wong RC. Effectiveness of endoscopy in patients admitted to the intensive care unit with upper GI hemorrhage. Gastrointest Endosc 2001;53:6-13.
Drbrueil. Observation Sur La Perforation De L′esophage Et De L′arta Thoracique Par Une Partion D′os Avale. Aves Des Reflexions. J Univ Sci Med 1818;9:357-65.
Chiari H. Uber Pemdkorperverletzung Des Oesopgagus Mit Aortenperforation. Berl Kiln Wochenschr 1914;51:7.
Hollander JE, Quick G. Aortoesophageal fistula: A comprehensive review of the literature. Am J Med 1991;91:279-87.
Sweeney MS, Gadacz TR. Primary aortoduodenal fistula: Manifestation, diagnosis, and treatment. Surgery 1984;96:492-7.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics - 2013 update: A report from the American Heart Association. Circulation 2013;127:143-52.
Yachimski PS, Friedman LS. Gastrointestinal bleeding in the elderly. Nat Clin Pract Gastroenterol Hepatol 2008;5:80-93.
Watanabe Y, Kashihara S, Kiyonari N, Tsuji Y, Hisano K, Okada M. Combined resection of the thoracic esophagus and thoracic descending aorta. Jpn J Thorac Cardiovasc Surg 1999;47:495-8.