PMC6033050_01
Oesophagogastroduodenoscopy images showed spurting of blood within the oesophageal lumen.
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He was appropriately resuscitated and an urgent oesophagogastroduodenoscopy (OGD) was carried out, which showed active spurting at the mid-oesophagus arising from a visible vessel (nipple sign) (Fig.1) with an underlying pulsating mass without any visible ulcer, suggestive of an aorto-oesophageal fistula.
Showing the oesophagus extremely compressed against the aorta.
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The oesophagus was seen to be extremely compressed by the aorta at the level corresponding to the bleeding point in the oesophagus (Fig.2).
Image showing patent supra-aortic branches at index presentation.
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All the supra-artic branches were patent (Fig.3) and there was no suggestion of visceral malperfusion.
Final position of the stent covering the left subclavian artery (LSA). Faint opacification of the LSA.
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A third stent was deployed to just above the coeliac artery, overlapping proximally with the stent grafts (Fig.4).
Post-stenting computed tomography aortogram showing the postion of the stent and thrombosed false lumen.
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Follow up CT aortogram done six weeks post-operatively demonstrated thrombosis of the false lumen of the descending thoracic aorta (Fig.5).
Position of stent graft on follow up scan at 2 years.
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The patient was started on lifelong oral antibiotics and to date has been followed up for 3 years with CT scans which have shown the thrombosed false lumen to be decreasing in size with no evidence of infection or repeat haemorrhage (Fig.6).