토혈을 동반하지 않은 대동맥식도누공의 내시경적 진단 1예
Endoscopic Diagnosis of Aortoesophageal Fistula Not Presenting Hematemesis
이종윤, 장진석, 김동균, 차재황, 최원종,
소속 상세정보
이종윤 ( Lee Jong-Yoon )
동아대학교병원 소화기내과
장진석 ( Jang Jin-Seok )
동아대학교병원 소화기내과
김동균 ( Kim Dong-Gyun )
동아대학교병원 소화기내과
차재황 ( Cha Jae-Hwang )
동아대학교병원 소화기내과
최원종 ( Choi Won-Jong )
동아대학교병원 소화기내과
Abstract
Aortoesophageal fistula (AEF) is an extremely rare but lethal cause of massive gastrointestinal hemorrhage. Characteristic symptoms are mid-thoracic pain, sentinel minor hemorrhage, and massive hemorrhage after a symptom-free interval. Prompt diagnosis and immediate treatments are necessary to reduce mortality. However, AEF is difficult to diagnose because it is uncommon and often leads to death with massive bleeding before proper evaluation. We report a case of endoscopic diagnosis of AEF that did not present with hematemesis; it was treated with thoracic endovascular aortic repair (TEVAR) and surgery. A 71-year-old female presented to the emergency department with epigastric discomfort. Endoscopy demonstrated a submucosal tumor-like protrusion and pulsating mass with blood clots. Contrast-enhanced chest CT confirmed AEF due to descending thoracic aortic aneurysm. The patient immediately underwent TEVAR to prevent massive bleeding and subsequently underwent surgery. Endoscopists should consider AEF if they see a submucosal tumor-like mass with a central ulcerative lesion or a pulsating protrusion covered with blood clots in mid-esophagus during an endoscopy.
키워드
Aortoesophageal fistula; Gastrointestinal hemorrhage; Aortic aneurysm; Endoscopy
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