Delayed presentation of aortoenteric fistula after esophagectomy

Aortoenteric fistula (AEF) is a rare but catastrophic complication following esophagectomy, often resulting in massive upper gastrointestinal bleeding and high mortality. While most cases occur early in the postoperative period, delayed presentations remain poorly understood. We report the case of a 54-year-old woman who underwent esophagectomy and gastric pull-up for mid-esophageal squamous cell carcinoma. Nine months postoperatively, the patient presented with hematemesis, hemorrhagic shock, and died despite resuscitative efforts. Autopsy revealed a 0.9 cm erosion in the descending thoracic aorta with adjacent ulceration of the gastric conduit and bacterial infiltration consistent with a thoracic AEF. This case illustrates a rare, delayed presentation of AEF confirmed by post-mortem analysis. It highlights the need for ongoing clinical vigilance even in patients with initially uncomplicated recoveries.