AORTOESOPHAGEAL FISTULA - CONGENITAL AND ACQUIRED CAUSES

Aortoesophageal fistula (AEF) is a rare but frequently lethal cause of upper gastrointestinal bleeding. This is a report of the authors' exp erience with four cases-two from congenital and two from acquired caus es. A review of the pediatric cases reported in the literature is incl uded. The mortality from AEF is high, and can be decreased in two ways . AEF can be prevented by avoiding prolonged nasogastric intubation in patients with known vascular rings, and by promptly removing esophage al foreign bodies and promptly treating periesophageal abscesses. Once an AEF occurs, it presents with typical large-herald upper gastrointe stinal bleeding of bright red blood, and cardiovascular collapse. Reco gnition of this pattern, with vigorous resuscitation and aggressive su rgical management, will improve the survival rate. Copyright (C) 1994 by W.B. Saunders Company