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Primary aortoesophageal fistula: presenting as massive upper gastrointestinal hemorrhage
S Nijhawan1, T Patni, S Agrawal
1Department of Gastroenterology, S.M.S. Medical College, Jaipur.
Insights
Primary aortoesophageal fistula, a rare cause of upper GI bleeding, was diagnosed in a child. This life-threatening condition involves an aortic aneurysm rupturing into the esophagus, leading to massive hemorrhage.
Area of Science:
- Cardiology
- Gastroenterology
- Pediatric Surgery
Background:
- Primary aortoesophageal fistula is an exceedingly rare and life-threatening condition.
- It presents as a critical cause of massive upper gastrointestinal bleeding, particularly in pediatric cases.
Observation:
- A six-year-old boy exhibited symptoms of severe upper gastrointestinal hemorrhage.
- Esophageal endoscopy identified a submucosal bulge with an ulcer and clot.
- Chest imaging, including skiagram and CT scan, revealed a posterior mediastinal mass consistent with a ruptured aortic aneurysm into the esophagus.
Findings:
- The diagnosis of primary aortoesophageal fistula was confirmed via CT scan.
- The patient's condition was critical, leading to a fatal outcome before surgical intervention.
Implications:
- This case highlights the importance of considering rare vascular anomalies in pediatric massive upper GI bleeding.
- Early and accurate diagnosis through advanced imaging is crucial for potential intervention.
- Further research into the management of this rare condition is warranted to improve patient outcomes.
Abstract:
Primary aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding. A six-year-old boy presented with massive upper gastrointestinal hemorrhage. Endoscopy revealed a submucosal bulge in the esophagus with an ulcer and clot at the top. Lateral skiagram of the chest showed a posterior mediastinal mass. CT scan of the chest revealed a ruptured aortic aneurysm into the oesophagus, confirmed the diagnosis. The patient succumbed to the illness before he could be subjected to definitive treatment.