1236

Abstract

Case Reports: Aortoesophageal fistula (AEF) is a rare but fatal complication associated with thoracic aortic aneurysm, foreign body ingestion, esophageal malignancy, chest trauma, prolonged nasogastric intubation, and postsurgical fistula formation. Isolated case studies have reported radiation and chemotherapy as etiologies of AEF. Chiari’s triad is classic of AEF and includes mid-thoracic pain or dysphagia, sentinel arterial hemorrhage, and final exsanguination after a symptom free interval. The prompt identification of massive gastrointesitinal hemorrhage that is bright red and arterial in nature is characteristic of AEF. Most cases are unrecognized or misdiagnosed and identified at autopsy. A systematic search for relevant articles, literature reviews, and case reports was performed using The Cochrane Library, PubMed, CINAHL, SCOPUS, and Ovid. Two patients, a 52 yo Arabic male and a 60 yo Hispanic male, both with metastatic squamous cell carcinoma of the esophagus and post-chemotherapy, presented with similar signs and symptoms of hematemesis and hemodynamic instability. They were admitted to the ICU where they subsequently developed uncontrollable hematemesis, requiring massive blood transfusions. Both patients were emergently taken to interventional radiology where AEF was confirmed. Each underwent successful placement of a stent graft in the thoracic aorta. One patient remained hemodynamically stable, was discharged 8 weeks later. The second patient died 72 hours later due to progressive respiratory failure secondary to ARDS associated with massive blood transfusions. The review of the literature indicates that 17% of AEF cases are associated with esophageal cancer. Until the early 2000s, the preferred treatment was surgical intervention. Most recently, case reports have shown endovascular repair (EVR) offers a safe and effective alternative for patients who are not surgical candidates secondary to their physical condition of the disease. Awareness of AEF is low due to the rarity of this pathology, however, early recognition and prompt endovascular intervention can decrease mortality associated with the exsanguination common in patients with AEF.