A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially revealed profuse bleeding at 20cm from the incisors, initially treated with an oesophageal covered stent. Following ongoing haematemesis, a thoracic and abdominal CT angiogram demonstrated an aorto-oesophageal fistula, which was successfully treated with a thoracic endograft and left tube thoracostomy. The patient remains well to 1 year. This is the first case to demonstrate successful use of covered stents in both the aorta to stop exsanguination, as well as the oesophagus to prevent mediastinitis and avoid the need for thoracotomy and hypothermic circulatory arrest in a critically ill patient.
- Vascular surgery
- GI bleeding
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Contributors All authors have met ICMJE criteria. NVJ and VG involved in conception and design of the case report. Involved in the decision making and management of the patient and drafting the case report article. SV involved in collecting the data from the patient medical notes, obtaining consent from the patient and eliciting the patient perspective. Also involved in reviewing the recent literature and drafting the case report write up. AT involved in conception and design of the case report. Involved in the decision-making and management of the patient, and overseeing final approval of the case report to be published.
Funding This study was funded by Imperial College London (200386).
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.