Aortoesophageal Fistula Causing Massive Gastrointestinal Bleeding and Death in a Patient with Dermatomyositis: A Case Report

The American Journal of Case Reports
Teressa Reanne JuYu-Chao Lin

Abstract

BACKGROUND Aortoesophageal fistula is a rare etiology of serious gastrointestinal bleeding. Most aortoesophageal fistulas resulted from thoracic aortic aneurysms, foreign bodies, or esophageal malignancy. To our knowledge, spontaneous aortoesophageal fistula due to dermatomyositis and high dose steroid therapy has not been reported. CASE REPORT A 46-year-old Asian female with a history of dermatomyositis and duodenal ulcers presented with black stool for one day. She was initially admitted for dermatomyositis flare-up and received high dose steroid therapy. Four weeks after discharge, she experienced gastrointestinal bleeding from multiple duodenal ulcers. Due to a continuous fall in hemoglobin level, she received angiography and embolization to the gastroduodenal artery. After the procedure, the patient developed another episode of dermatomyositis flare-up and required endotracheal intubation. During ventilator weaning, she developed recurrent gastrointestinal bleeding. Repeated esophagogastroduodenoscopy showed one esophageal ulcer with active bleeding. Epinephrine hemostasis therapy was performed but with poor therapeutic response. Angiography showed no visible extravasation. Chest computed tomography with intravenous contra...Continue Reading

Citations

Dec 18, 2019·Surgery Today·Shinsuke TakenoKunihide Nakamura

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