Oesophago-aortic fistula.

Case report A 19-year-old boy was transferred from a longstay hospital for the handicapped, after having passed melaena stools, vomited bright blood and having become shocked. In the past 6 months he had been noted to be anaemic and barium examination had been reported as showing a hiatus hernia and a duodenal ulcer. On admission, the patient was vomiting bright red blood profusely and passing melaena stools. He was shocked with a pulse of 120/min and a BP of 60 mmHg systolic. Despite being transfused 6 units of blood, his condition improved only temporarily, his hypotension and tachycardia recurring with copious quantities of fresh blood being vomited. The patient was transferred direct to the operating theatre. At laparotomy, the stomach was distended with more than 2 litres of clotted blood. Gastrotomy and digital examination through the cardia revealed an ulcer approximately 10 cm above the hiatus. The aortic wall was palpable through the ulcer. Haemorrhage was controlled by digital pressure whilst the left chest was opened. Dense inflammatory adhesions were found between the descending thoracic aorta and the lower third of the oesophagus. The aorta was freed and clamped, permitting repair of the aorta with 3/0 silk. The oesophagus was closed with catgut and wrapped posteriorly with Dacron mesh. The patient recovered well, with only a superficial wound infection. At follow-up 3 years later he remained asymptomatic and his blood count was normal. Barium swallow examination at that time was clear.