Oesophageal bleeding from aortoesophageal fistula due to aortic aneurysm
Myers, H.S.; Silber, W.
South African Medical Journal 63(4): 124-127
1983
ISSN/ISBN: 0256-9574 PMID: 6600293 Document Number: 207619
From pathology data it appears that aortic aneurysm may be the commonest cause of aorto-oesophageal fistula (AOF), but this entity is rarely diagnosed clinically. We report 6 patients, seen during a 5-year period, with aneurysms which initially caused chest pain and minor oesophageal bleeding. The diagnosis of AOF was made before death in only 1 case; surgery was not attempted. This patient and 4 others died when rupture into the oesophageal lumen or wall caused exsanguinating haemorrhage. The 6th patient, who died after prostatectomy without a major haemorrhage, had oesophageal fibrosis localized at the aneurysm; this type of lesion occurs in the development of a fistula. The therapeutic ideal is to forestall fatal rupture by prompt diagnosis and immediate surgery when mild oesophageal bleeding gives warning of fistula formation.