Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11493
Peer-review started: May 7, 2022
First decision: June 27, 2022
Revised: July 27, 2022
Accepted: September 23, 2022
Article in press: September 23, 2022
Published online: November 6, 2022
Aorto-esophageal fistula is an extremely rare cause of acute upper gastrointestinal bleeding (UGIB).
We present a case of an 80-year-old woman with esophageal cancer who was admitted to our department with hemorrhagic shock due to UGIB. During the diagnostic procedure, emergency computed tomography angiography was performed and confirmed aorto-esophageal fistula. Interventional radiologists inserted a stent graft into the aorta, successfully closing the fistula. Unfortunately, the patient later died of heart failure following irreversible hemorrhagic shock. Autopsy confirmed the aorto-esophageal fistula, which formed 1 cm below the distal edge of the stent previously inserted into the esophagus for a malignant stricture.
There are very rare causes of UGIB. Although clinical decisions are made during the diagnostic workup of these patients, we must be aware of the limitations of various therapeutic options, even the most contemporary.
Core Tip: Acute upper gastrointestinal bleeding (UGIB) is a life-threatening condition. Although most UGIB cases have a benign course, only a few have a severe and fatal outcome. Improved diagnostic and therapeutic options have been made possible, in particular, by technological advances in interventional endoscopy, radiology and minimally invasive, laparoscopic surgery. In the paper, the authors present a patient with UGIB caused by an aorto-esophageal fistula, which formed due to a stent inserted into the middle third of the esophagus for advanced cancer. Despite appropriate and timely clinical decisions, the outcome of treatment was fatal.