Aortoesophageal fistula: A rare and dreaded cause of gastrointestinal haemorrhage

Abstract

Aortoesophageal fistula (AEF) is an uncommon cause of gastrointestinal bleeding. Most cases are identified post‐mortem after an exsanguinating haemorrhage. Common causes include rupture of thoracic aortic aneurysm, oesophageal foreign bodies and thoracic surgery. AEF following previous aortic or oesophageal surgery are termed as secondary AEF, whereas fistulas that are the result of a ruptured aortic aneurysm, aortic dissection, foreign bodies, oesophageal cancer etc. are termed as primary AEF. The presentation is with the classic Chiari's triad, however, not all components might be present. Endoscopy, computed tomography scan and aortography are useful for diagnosis and for identifying the site of the fistula. Emergency surgery is the treatment of choice, although isolated reports of aortic stenting are available. Aortic repair, restoration of circulation and delayed oesophageal reconstruction are essential principles in the management of aortoesophageal fistula. With early recognition and proper management, more survivors are being reported in literature.