J Korean Med Sci.  2002 Apr;17(2):266-269. 10.3346/jkms.2002.17.2.266.

Aortoesophageal Fistula Associated with Tuberculous Mediastinitis, Mimicking Esophageal Dieulafoy's Disease

• Lee OJ
• Kim SH

• KMID: 648689
• DOI: http://doi.org/10.3346/jkms.2002.17.2.266

Abstract

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication.

Keyword

Esophageal Fistula; Aortic Diseases; Tuberculosis; Dieulafoy's Disease

MeSH Terms

Adult
*Aorta, Thoracic/pathology/surgery
Aortic Diseases/*etiology/pathology/surgery
Esophageal Fistula/*etiology/pathology/surgery
*Esophagus/pathology/surgery
Fatal Outcome
Female
Hematemesis/etiology/pathology/surgery
Humans
Mediastinitis/pathology
Tuberculosis, Miliary/*complications