Aortoesophageal Fistula-Induced Rare Life-Threatening Hematemesis in the Emergency Department: A Case Series and Literature Review

Background and objective Aortoesophageal fistula (AEF) is a rare but life-threatening condition. It is often challenging to promptly diagnose AEF given the diversity of chief complaints and clinical presentations at the time of initial treatment. In some cases, upper gastrointestinal endoscopy is performed, and emergency surgery is delayed, or the disease is judged to be mild and rapidly worsens, ultimately resulting in the patient's death. In this study, we aimed to investigate the clinical characteristics of AEF in patients at the time of emergency department visits, which were only partially described in previous studies. Methods We retrospectively reviewed the medical records of patients diagnosed with AEF from May 2013 to May 2023 at a tertiary medical center in Japan. Results Six patients were diagnosed with AEF during the study period. The median age of the patients was 75.5 years, and four were females. All six patients had the chief complaint of hematemesis; three (50%) had bright red hematemesis and four (67%) had a relatively small amount of hematemesis. Two (33%) experienced syncope. Three (50%) were clinically diagnosed with shock upon arrival at the hospital. Four (67%) had a history of post-aortic surgery, aortic aneurysm, or esophageal cancer. Conclusions AEF should be considered in patients with hematemesis, especially those with distinctive underlying diseases, shock, or syncope, even if hematemesis only involves a small amount of blood or is bright red.