[Major esophageal hemorrhages of unusual origin. A poorly known entity]

Nine cases of severe gastrointestinal haemorrhage as the presentation of oesophageal lesions are reported. Haemorrhages complicating oesophageal varices, carcinoma of the oesophagus and oesophageal surgery were eliminated from the study, as were haemorrhages associated with hiatal hernias or Mallory-Weiss syndrome. Amongst these 9 cases of severe haemorrhage, 5 were due to an ulcer of the oesophagus, 2 to acute oesophagitis, 1 to rupture of the oesophagus and one to a traumatic aneurysm of the aorta rupturing into the oesophagus. The location and cause of bleeding were determined only 3 times before operation and only when a fibroscopic examination had been carried out. At fibroscopy, an irregular lesion responsible for a severe haemorrhage has every chance of being a benign ulcer and not a carcinoma. Treatment directed at the aetiology was carried out in 6 cases and success obtained in 3 patients. The aetiological diagnosis who was not made in 3 patients, who died. The aetiology, diagnosis and therapeutic approach required in such cases of severe haemorrhage of oesophageal origin are considered. In the light of these cases, a possible oesophageal aetiology should be considered as a possible cause of an unexplained severe gastrointestinal haemorrhage. An attempt at proving such a hypothesis by fibroscopy is necessary and, in general, urgent thoracotomy since the bleeding is in most instances of arterial origin.