Aorto-esophageal fistula: successful open surgical managemen
An aorto-esophageal fistula (AEF) is a rare yet life-threatening cause of upper gastrointestinal (UGI) bleeding. The disease typically has a high mortality rate, with few reported survivors. The common causes of AEF are thoracic aortic aneurysms, trauma, carcinoma esophagus, and radiation. The clinical characteristics of AEF are unique and a presumptive diagnosis may be made at presentation. It classically presents with the triad of mid-thoracic pain, sentinel arterial hemorrhage and exsanguination after a symptom-free interval.

Here reported two cases of aorto-esophageal fistula presented in OXFORD's journal of surgical case report. Both cases presented with almost identical presentations: hematemesis and hemodynamic instability. The aorta in the first patient was normal; the defect was small and was repaired with a Dacron patch. The second patient had an aneurysmal aorta, which was replaced with a Dacron graft. Both cases were performed under partial bypass. The esophageal rent in both patients was debrided, primarily closed and buttressed with a vascularized intercostal pedicle. Nonavailability of endovascular personnel and equipment along with hemodynamic instability of the patient influenced surgical strategy. Long-term follow-up of these patients is necessary to analyze the outcomes of surgical repair.

The diagnosis of an AEF usually warrants urgent, if not emergent intervention, especially if accompanied by bleeding and hemodynamic instability. The management consists of mandatory control of the bleeding site with definitive aortic treatment, accompanied by methods to stop continuous contamination of the aortic prosthesis through the fistula