PT  - JOURNAL ARTICLE
AU  - Dean Burns
AU  - Dhakshinamoorthy Vijayasankar
TI  - Mind the fistula
AID  - 10.1136/fg.2010.004119
DP  - 2011 Jul 01
TA  - Frontline Gastroenterology
PG  - 151--152
VI  - 2
IP  - 3
4099  - http://fg.bmj.com/content/2/3/151.short
4100  - http://fg.bmj.com/content/2/3/151.full
SO  - Frontline Gastroenterol2011 Jul 01; 2
AB  - Thoracic aortic dissection (TAD) with aorto-oesophageal fistula formation is an uncommon but fatal cause of haematemesis. A case is presented of a previously healthy 63-year-old man who presented to the emergency department with syncope and haematemesis. He had no history of heavy alcohol intake and was previously well. Bedside portable chest x ray revealed a widened mediastinum and, while awaiting a CT angiogram, he had a further large haematemesis which led to him undergoing resuscitation and rapid sequence intubation. CT angiography of his thoracic aorta revealed a large thoracic aortic aneurysm with dissection from the arch of the aorta down to the left iliac artery. The dissection had formed an aorto-oesophageal fistula in the proximal oesophagus. He was transferred to a tertiary referral centre for repair of the dissection and aorto-oesophageal fistula.