# Upper gastrointestinal bleeding from primary aortoesophageal fistula in a patient with aneurism of the thoracoabdominal aorta: Case report and literature review

## TL;DR

A rare case of upper gastrointestinal bleeding caused by a primary aortoesophageal fistula in a patient with a thoracoabdominal aortic aneurysm is reported, highlighting the need for rapid diagnosis and multidisciplinary care.

## Contribution

This case report adds to the limited literature on primary aortoesophageal fistulas and emphasizes the importance of clinical awareness for timely intervention.

## Key findings

- A 55-year-old male presented with back pain and upper gastrointestinal bleeding due to a primary aortoesophageal fistula.
- Computed tomography confirmed a thoracoabdominal aortic aneurysm with active contrast extravasation.
- Despite urgent surgical repair, the patient had a lethal outcome, underscoring the high mortality risk of this condition.

## Abstract

Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option.

We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55‐year‐old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment.