Aortoesophageal fistula: recognition and diagnosis in the emergency department.
Publication/Presentation Date
10-1-1998
Abstract
An aortoesophageal fistula is a life-threatening cause of gastrointestinal bleeding where an abnormal communication between the esophagus and the aorta may result from a thoracic aortic aneurysm, foreign body ingestion, esophageal malignancy, or postoperative complications. The diagnosis can be made on the basis of clinical findings alone. Classic patients present with the triad of midthoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval (Chiari's triad). The identification of massive upper gastrointestinal hemorrhage that is bright red and arterial in nature is characteristic. Most diagnostic tests have significant individual limitations. Endoscopy of the upper gastrointestinal tract should exclude alternative bleeding sources and may show a submucosal hematoma. Aortography may be useful during active hemorrhage to demonstrate the fistula, but results of aortography may be negative during the symptom-free interval. Dynamic computed tomography may be a more rapid alternative. For patients who are in stable condition after the sentinel hemorrhage, a confirmatory test is reasonable. Patients in unstable condition should undergo immediate surgery. Survival is now possible with rapid surgical intervention.
Volume
32
Issue
4
First Page
502
Last Page
505
ISSN
0196-0644
Published In/Presented At
Heckstall, R. L., & Hollander, J. E. (1998). Aortoesophageal fistula: recognition and diagnosis in the emergency department. Annals of emergency medicine, 32(4), 502–505. https://doi.org/10.1016/s0196-0644(98)70182-9
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
9774937
Department(s)
Administration and Leadership
Document Type
Article