Lee Jong Yoon, Jang Jin Seok, Kim Dong Kyun, Cha Jae Hwang, Choi Won Jong
Department of Gastroenterology, Dong-A University Hospital, Busan, Korea.
Korean J Gastroenterol. 2019 Jan 25;73(1):35-38. doi: 10.4166/kjg.2019.73.1.35.
Aortoesophageal fistula (AEF) is an extremely rare but lethal cause of massive gastrointestinal hemorrhage. Characteristic symptoms are mid-thoracic pain, sentinel minor hemorrhage, and massive hemorrhage after a symptom-free interval. Prompt diagnosis and immediate treatments are necessary to reduce mortality. However, AEF is difficult to diagnose because it is uncommon and often leads to death with massive bleeding before proper evaluation. We report a case of endoscopic diagnosis of AEF that did not present with hematemesis; it was treated with thoracic endovascular aortic repair (TEVAR) and surgery. A 71-year-old female presented to the emergency department with epigastric discomfort. Endoscopy demonstrated a submucosal tumor-like protrusion and pulsating mass with blood clots. Contrast-enhanced chest CT confirmed AEF due to descending thoracic aortic aneurysm. The patient immediately underwent TEVAR to prevent massive bleeding and subsequently underwent surgery. Endoscopists should consider AEF if they see a submucosal tumor-like mass with a central ulcerative lesion or a pulsating protrusion covered with blood clots in mid-esophagus during an endoscopy.
主动脉食管瘘（AEF）是导致大量胃肠道出血的一种极其罕见但致命的病因。其特征性症状为胸中部疼痛、前驱性少量出血以及在无症状期后出现大量出血。为降低死亡率，必须进行及时诊断和立即治疗。然而，AEF难以诊断，因为其并不常见，且常在进行适当评估前因大量出血导致死亡。我们报告一例未出现呕血症状的AEF经内镜诊断的病例；该病例接受了胸段血管腔内主动脉修复术（TEVAR）和手术治疗。一名71岁女性因上腹部不适就诊于急诊科。内镜检查显示一个黏膜下肿瘤样隆起以及一个伴有血凝块的搏动性肿物。增强胸部CT证实为降主动脉瘤导致的AEF。患者立即接受TEVAR以预防大量出血，并随后接受了手术。内镜医师在内镜检查时，如果在食管中段看到一个伴有中央溃疡性病变的黏膜下肿瘤样肿物或一个覆盖有血凝块的搏动性隆起，应考虑AEF。
