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Review
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Korean J Med. 2006;71(1):206-206.
- A case of aortoesophageal fistula presenting as Dieulafoy like lesion
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Dae Jin Kim, Yun Jin Chung, Ju Young Lee, Wan Suk Lee, Hyun Chaol Lee, Min Kyu Jung, Seong Woo Jeon
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- A case of aortoesophageal fistula presenting as Dieulafoy like lesion
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국립의료원 내과
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- Abstract
- A 68-year-old woman transferred to our hospital from a district hospital because of hematemesis. Her hemoglobin was 9 g/dl.
Emergent endoscopy showed a exposed vessel with blood oozing at upper esophagus. Angiography and chest CT demonstrated
the presence of extravasation of contrast into the esophagus from the descending aorta. She had emergent surgery and the
intraoperative findings revealed aortoesophageal fistula and necrotic materials with foul odor at the upper esophagus. Primary
closure and wrapping of the aorta were performed but primary closure of the esophagus was impossible because of necrosis.
On the 10th postoperative day, a large volume of bloody effusion was drained through the chest tube and copious hematemesis
was developed. It suggested the disruption of the aortic closure. The patient is at high risk for reoperation because of deteriorated
condition and died of excess bleeding. Aortoesophageal fistula is a rare but life-threatening disease. The causes are aortic
aneurysm, ingestion of the foreign body, trauma, graft-esophageal fistula after vascular surgery, advanced esophageal cancer and
endoscopic procedures. As shown in our case, exposed vessel without ulceration at upper esophagus should raise the suspicion
of AEF, thus CT scan or angiography should be preceeded before endoscopic intervention.
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