Aorto-Oesophageal Fistula Presenting With Massive Upper Gastrointestinal Haemorrhage in Early Childhood: A Case Report

Aorto-oesophageal fistula is an exceptionally rare but life-threatening cause of upper gastrointestinal bleeding in children. Early diagnosis is challenging because of its nonspecific presentation and rapid clinical deterioration. We report the case of a previously healthy young child who presented with massive haematemesis following a short viral prodrome and rapidly developed haemorrhagic shock. Initial laboratory investigations demonstrated severe acute anaemia requiring activation of the massive haemorrhage protocol and blood product resuscitation. Computed tomography imaging revealed abnormal vascular communication between the thoracic aorta and oesophagus consistent with an aorto-oesophageal fistula associated with significant aortic malformation. The patient required urgent multidisciplinary management, including intubation, transfer to a tertiary paediatric intensive care unit, and endovascular repair with covered aortic stent placement. Extensive investigations excluded infectious, inflammatory, and connective tissue disorders. The child recovered well following intervention, was gradually reintroduced to enteral feeding, and was discharged with ongoing specialist follow-up. This case highlights the importance of considering vascular causes in unexplained massive paediatric haematemesis. Prompt cross-sectional imaging, early haemodynamic stabilization, and multidisciplinary intervention are essential for survival. Endovascular repair may provide a life-saving minimally invasive treatment option in selected paediatric patients.