Gomes Samira Ineida Morais, de Campos Fernando Peixoto Ferraz, Martines Brenda Margatho Ramos, Martines João Augusto Dos Santos, Tafner Edmar, Maruta Luis Masuo
Heart Institute - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil.
Department of Internal Medicine - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.
Autops Case Rep. 2011 Dec 31;1(4):57-63. doi: 10.4322/acr.2011.018. eCollection 2011 Oct-Dec.
Acute upper gastrointestinal bleeding is a potentially life-threatening emergency, especially in the elderly. This condition accounts for approximately 1% of all emergency room admissions. Among the causes of such bleeding is aortoesophageal fistula, a dreaded but apparently rare condition, first recognized in 1818. The great majority of cases are of primary aortoesophageal fistula, caused by atheromatous aortic aneurysms or, less frequently, by penetrating aortic ulcer. The clinical presentation of aortoesophageal fistula is typically characterized by the so-called Chiari's triad, consisting of thoracic pain followed by herald bleeding, a variable, short symptom-free interval, and fatal exsanguinating hemorrhage. The prognosis is poor, the in-hospital mortality rate being 60%. Conservative treatment does not prolong survival, and the in-hospital mortality rate is 40% for patients submitted to conventional surgical treatment. Here, we report the case of a 93-year-old woman who presented to the emergency room with a history of hematemesis. The patient was first submitted to upper gastrointestinal endoscopy, the findings of which were suggestive of aortoesophageal fistula. The diagnosis was confirmed by multidetector computed tomography of the chest. Surgery was indicated. However, on the way to the operating room, the patient presented with massive bleeding and went into cardiac arrest, which resulted in her death.
急性上消化道出血是一种潜在的危及生命的急症，在老年人中尤为如此。这种情况约占所有急诊室入院病例的1%。此类出血的原因之一是主动脉食管瘘，这是一种可怕但显然罕见的病症，于1818年首次被认识到。绝大多数病例是原发性主动脉食管瘘，由动脉粥样硬化性主动脉瘤引起，较少见的是由穿透性主动脉溃疡引起。主动脉食管瘘的临床表现通常以所谓的奇阿里三联征为特征，包括胸痛继以先兆性出血、一段长短不一的无症状间隔期以及致命性大出血。预后很差，住院死亡率为60%。保守治疗不能延长生存期，接受传统手术治疗的患者住院死亡率为40%。在此，我们报告一例93岁女性患者，她因呕血病史就诊于急诊室。患者首先接受了上消化道内镜检查，检查结果提示主动脉食管瘘。胸部多排螺旋计算机断层扫描证实了诊断。需进行手术。然而，在前往手术室的途中，患者出现大量出血并发生心脏骤停，最终导致死亡。
