Kobayashi Masahiro, Fukaguchi Kiyomitsu, Koyama Hiroshi, Taguchi Azusa, Sekine Ichiro, Yamagami Hiroshi
Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, JPN.
Division of Critical Care, Shonan Kamakura General Hospital, Kanagawa, JPN.
Cureus. 2025 Mar 22;17(3):e80980. doi: 10.7759/cureus.80980. eCollection 2025 Mar.
Background and objective Aortoesophageal fistula (AEF) is a rare but life-threatening condition. It is often challenging to promptly diagnose AEF given the diversity of chief complaints and clinical presentations at the time of initial treatment. In some cases, upper gastrointestinal endoscopy is performed, and emergency surgery is delayed, or the disease is judged to be mild and rapidly worsens, ultimately resulting in the patient's death. In this study, we aimed to investigate the clinical characteristics of AEF in patients at the time of emergency department visits, which were only partially described in previous studies. Methods We retrospectively reviewed the medical records of patients diagnosed with AEF from May 2013 to May 2023 at a tertiary medical center in Japan. Results Six patients were diagnosed with AEF during the study period. The median age of the patients was 75.5 years, and four were females. All six patients had the chief complaint of hematemesis; three (50%) had bright red hematemesis and four (67%) had a relatively small amount of hematemesis. Two (33%) experienced syncope. Three (50%) were clinically diagnosed with shock upon arrival at the hospital. Four (67%) had a history of post-aortic surgery, aortic aneurysm, or esophageal cancer. Conclusions AEF should be considered in patients with hematemesis, especially those with distinctive underlying diseases, shock, or syncope, even if hematemesis only involves a small amount of blood or is bright red.
背景与目的 主动脉食管瘘（AEF）是一种罕见但危及生命的疾病。鉴于初始治疗时主要症状和临床表现的多样性，及时诊断AEF往往具有挑战性。在某些情况下，会进行上消化道内镜检查，从而延误急诊手术，或者判断病情较轻但病情迅速恶化，最终导致患者死亡。在本研究中，我们旨在调查急诊就诊时AEF患者的临床特征，此前的研究仅对其进行了部分描述。方法 我们回顾性分析了2013年5月至2023年5月在日本一家三级医疗中心诊断为AEF的患者的病历。结果 在研究期间，6例患者被诊断为AEF。患者的中位年龄为75.5岁，4例为女性。所有6例患者的主要症状均为呕血；3例（50%）为鲜红色呕血，4例（67%）呕血量相对较少。2例（33%）出现晕厥。3例（50%）入院时临床诊断为休克。4例（67%）有主动脉手术后、主动脉瘤或食管癌病史。结论 对于呕血患者，尤其是那些有特殊基础疾病、休克或晕厥的患者，即使呕血仅涉及少量血液或为鲜红色，也应考虑AEF。
