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While this scenario was a traumatic cause of oesophageal-aortic fistula, it should be noted that there are non-traumatic causes of the same. In fact, these fistulae can be caused by compression of the aorta from an aneurysm, advanced gastrointestinal malignancies or erosion of an aortic graft into adjacent gastrointestinal tract and can occur anywhere along the length of the aorta.
Aorto-enteric fistulas are life-threatening. The most common presentation is gastrointestinal bleeding and can present as either minor bleeding or a large life-threatening bleed that results in haemodynamic compromise. Patients can present with melaena (dark sticky faeces containing partly digested blood) or frank bleeding in stools. In smaller fistulas with slow, minor bleeds, patients can present with malaise or ischaemia of lower limbs due to less blood flow from the aortic bleed. Other presentations include haematemesis as occurred in this case.
Diagnoses of these fistulas can be difficult, depending on the cause, size and location of the fistula. In a stable patient, endoscopic exploration or CT angiography may be first line options for diagnosis. However, diagnosis in hemodynamically unstable patients is more time critical and may require laparotomy as well stabilisation with blood transfusions.
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