Endoscopic diagnosis of secondary aortoesophageal fistula

Secondary aortoesophageal fistula (AEF) is a catastrophic complication of endovascular graft placement [ 1 ]. The typical symptom of secondary AEF is massive gastrointestinal bleeding with a history of thoracic aortic aneurysm repair [ 2 ]. Endoscopy is the most sensitive and specific diagnostic study [ 3 ]. Endoscopy should be carefully performed, as it excludes other, more common causes of upper gastrointestinal bleeding, but should be terminated if a fistula is identified. We present an endoscopic finding of secondary AEF. A 60-year-old woman was diagnosed with a mycotic thoracoabdominal aortic aneurysm and underwent resection of the aneurysm with an in-situ prosthetic interposition graft. Two weeks later, she developed massive hematemesis with hypotension. Emergency esophagoscopy revealed that the graft had eroded into the upper esophagus, with active bleeding ([ Fig. 1 ]). Angiography with endovascular stenting and coil embolization were performed but failed to control the bleeding ([ Fig. 2 ]). The patient died from exsanguinating hemorrhage.