Aortoesophageal fistula: early postoperative complication at the distal anastomosis of an aortic graft.

Though secondary aortoesophageal fistula and subsequent hemorrhage is rare, the clinician must have a high index of suspicion to establish the correct diagnosis and institute appropriate treatment. We have proposed an algorithm to help prevent a massive hemorrhage such as the one that proved fatal in our patient. In the case of massive upper gastrointestinal hemorrhage, a Sengstaken-Blakemore tube should be done expeditiously. In the case of sentinel hemorrhage, aortography is the initial diagnostic procedure of choice, followed by flexible esophagogastroscopy if necessary.