Fatal foreign-body aorto-esophageal fistula: a predictable accident?

BACKGROUND: The ingestion of foreign bodies is the second most frequent cau se of aorto-esophageal fistulization after aneurysms of the thoracic aorta. CASE REPORT: A 28-year-old man died from catastrophic hematemesis 7 days af ter ingesting a bone splinter, The CT scan performed 3 days before the fata l event had demonstrated a fistulous formation originating in the aorta. DISCUSSION: Aorto-esophageal fistulae develop progressively from the esopha geal perforation caused by the foreign body. Clinically, there is medial ch est pain, followed by arterial hematemesis and finally terminal exsanguinat ion. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs.