Primary aorto-esophageal fistula due to Takayasu's aortitis.

BACKGROUND

Aneurysmal dilatation in Takayasu's arteritis is a recognized complication; however, fistula formation, especially to the esophagus, is very rare.

METHODS

A 22-year-old male presented with severe hematemesis. Investigation by means of esophagogastroscopy and CT scan revealed a saccular aneurysm in the proximal descending aorta with communication to the esophagus. The patient was taken to theater, the aneurysm excised and replaced by a graft.

RESULTS

Gross examination of the aneurysm showed multiple points of outpouching from the aneurysm. Histopathological examination of the showed marked intimal fibromyxoid thickening, loss of outer medial muscle and elastic fibers and marked fibrosis of the adventitial layer. The histological features were in keeping with Takayasu's arteritis. No evidence of tuberculosis was noted.

CONCLUSIONS

This case illustrates an unusual complication of Takayasu's arteritis, in the form of a fistula between the aorta and the esophagus, which resulted in massive hematemesis and the ultimate demise of the patient.