1/8. Primary aorto-oesophageal fistula due to oesophageal carcinoma. Report of a successfully managed case.Aorto-oesophageal fistula is a rare but often fatal entity causing upper gastrointestinal bleeding. Amongst the different aetiologies described, the commonest is rupture of a thoracic aortic aneurysm into the oesophagus. This entity was first reported in 1818, and only recently have successfully treated cases been published. Other causes such as postoperative complications, tuberculosis and trauma are less common. Oesophageal malignancy perforating the aorta is a rarity. The authors describe a case of aortic perforation secondary to an oesophageal carcinoma, treated with initial success. The clinical onset was a massive upper gastrointestinal haemorrhage. The diagnosis, once the bleeding was controlled, was arrived at after CT-scanning and arteriography. A Dacron prosthesis was interposed into the descending thoracic aorta to restore aortic flow; later an oesophagectomy plus oesophagostomy and jejunostomy were carried out.- - - - - - - - - - ranking = 1keywords = gastrointestinal haemorrhage, haemorrhage (Clic here for more details about this article) |
2/8. Fatal aortoesophageal fistula in two cases of tight vascular ring.Vascular rings are rare vascular congenital anomalies causing oesophageal and tracheal compression. An aortoesophageal fistula is a devastating, in part iatrogenic, complication of vascular rings. It is seen with increasing frequency, and can be misleading, since differential diagnosis with other causes of haematemesis and melaena is often difficult, especially in infants. We report two infants with aortoesophageal fistulas secondary to double aortic arches forming a vascular ring. In both, the diagnosis was missed, and massive haemorrhage led to death. In both cases, the fissuration on the oesophageal and aortic sides of the fistula had sharp edges, highly suggestive of an iatrogenic laceration caused by manipulation of nasogastric tubes. The key for the diagnosis of vascular rings is, therefore, clinical suspicion and awareness of this condition. Prompt identification in infants with stridor, wheezing, or respiratory distress can prevent prolonged intubation, thus avoiding the formation of an aortoesophageal fistula and hopefully preventing a fatal outcome.- - - - - - - - - - ranking = 0.016632773372583keywords = haemorrhage (Clic here for more details about this article) |
3/8. Aorto-oesophageal fistula complicating tuberculous aortitis. A case report.A case of massive upper gastro-intestinal haemorrhage in a Black woman owing to tuberculous aorto-oesophageal fistula is reported. The literature is reviewed and the clinical presentation discussed. This possibly represents only the second case of aorto-oesophageal fistula complicating postprimary tuberculosis to appear in medical literature.- - - - - - - - - - ranking = 0.016632773372583keywords = haemorrhage (Clic here for more details about this article) |
4/8. Dysphagia aortica: a neglected symptom of aortoesophageal fistula.Aortoesophageal fistula, secondary to thoracic aortic aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. Typical symptoms are midthoracic pain and/or dysphagia followed by a usually short, albeit unpredictable, symptom-free interval and by a 'herald' haemorrhage, which is observed in 80% of patients before fatal exsanguinations. Dysphagia is present in 45% of patients, sometimes for several weeks, before the first bleeding occurs. However, dysphagia aortica is rarely considered in the differential diagnosis of dysphagia and lack of awareness, as well as symptom's underevaluation, both contribute to a significant diagnostic and therapeutic delay. We present a case of a 77-year-old woman who died for a bleeding AEF consequent to a thoracic aortic aneurysm and whose main symptom during the past 2 months was dysphagia, which was not taken seriously into consideration by her general practitioner. This case report emphasises that primary care physicians should be alerted to evaluate carefully the alarming symptoms like dysphagia -- especially in elderly patients -- before life threatening complications occur, as they are the ones who could suspect early the diagnosis and make a proper referral.- - - - - - - - - - ranking = 0.016632773372583keywords = haemorrhage (Clic here for more details about this article) |
5/8. Arterioenteric fistulae: diagnosis and treatment by angiography.Two cases of massive gastrointestinal haemorrhage caused by arterioenteric fistulae are presented. In both cases, bleeding was controlled by interventional angiography. In the first case, a fistula between an aberrant right subclavian artery and a reconstructed oesophagus was temporarily occluded with a balloon catheter as a pre-surgical measure. In the second case a communication between the external iliac artery and the colon in a patient with invasive cervical cancer was treated by embolization. An arterioenteric fistula should be considered as a possible cause of acute gastrointestinal haemorrhage in post-operative or cancer patients and aortography or pelvic arteriography may be required to make the diagnosis.- - - - - - - - - - ranking = 2keywords = gastrointestinal haemorrhage, haemorrhage (Clic here for more details about this article) |
6/8. Sudden death from perforation of a benign oesophageal ulcer into a major blood vessel.Two cases of sudden death due to perforation of a benign oesophageal ulcer into a major blood vessel are reported. In one man, anaemia and aspiration pneumonitis dominated the clinical picture. He had an oesophageal stricture and a chronic peptic ulcer associated with an incarcerated hiatus hernia. death was due to haemorrhage caused by perforation of the ulcer into the thoracic aorta. The second patient presented with confusion and falls, backache and indigestion. She had a hiatus hernia and a large benign chronic oesophageal ulcer. death was due to perforation of the ulcer into the left pulmonary vein. The cases are presented for their rarity, to illustrate the complex and late presentation of problems in geriatric medicine, and as a reminder that reflux oesophagitis can be dangerous.- - - - - - - - - - ranking = 0.016632773372583keywords = haemorrhage (Clic here for more details about this article) |
7/8. Oesophageal bleeding from aortoesophageal fistula due to aortic aneurysm.From pathology data it appears that aortic aneurysm may be the commonest cause of aorto-oesophageal fistula (AOF), but this entity is rarely diagnosed clinically. We report 6 patients, seen during a 5-year period, with aneurysms which initially caused chest pain and minor oesophageal bleeding. The diagnosis of AOF was made before death in only 1 case; surgery was not attempted. This patient and 4 others died when rupture into the oesophageal lumen or wall caused exsanguinating haemorrhage. The 6th patient, who died after prostatectomy without a major haemorrhage, had oesophageal fibrosis localized at the aneurysm; this type of lesion occurs in the development of a fistula. The therapeutic ideal is to forestall fatal rupture by prompt diagnosis and immediate surgery when mild oesophageal bleeding gives warning of fistula formation.- - - - - - - - - - ranking = 0.033265546745166keywords = haemorrhage (Clic here for more details about this article) |
8/8. Fatal haematemesis from an aorto-oesophageal fistula of obscure aetiology: a case report.endoscopy, aortography and laparotomy failed to demonstrate a high aorto-oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid-thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom-free interval, and therapeutic embolization as a mode of therapy, are discussed.- - - - - - - - - - ranking = 0.016632773372583keywords = haemorrhage (Clic here for more details about this article) |