Life-threatening gastrointestinal bleeding caused by perforation of a penetrating atherosclerotic ulcer into the esophagus

被引：0
作者：
Yoko Kimura
Kenji Nakamura
Daiki Kojima
Tadashi Katayama
Sakiko Takarabe
Hiroshi Kishikawa
Aya Sasaki
Tadakazu Hisamatsu
Jiro Nishida
机构：
[1] Kyorin University School of Medicine,Department of Gastroenterology and Hepatology
[2] Ichikawa General Hospital,Department of Gastroenterology, Tokyo Dental College
[3] Keio University School of Medicine,Department of Endocrinology, Metabolism, and Nephrology
[4] Ichikawa General Hospital,Department of Clinical Laboratory, Tokyo Dental College
来源：
Clinical Journal of Gastroenterology | 2023年 / 16卷
关键词：
Penetrating atherosclerotic ulcer; Aortoesophageal fistula; Upper gastrointestinal bleeding;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
We present a case of life-threatening gastrointestinal bleeding caused by a penetrating atherosclerotic ulcer (PAU) that ruptured into the esophagus. A 65-year-old man presented with pyrexia and nausea. Contrast-enhanced computed tomography (CT) performed on admission revealed a hematoma between the lower esophagus and descending aorta due to a contained rupture of a PAU, which was undiagnosed at that time. Esophagogastroduodenoscopy (EGD) performed on the fifth day of admission revealed a subepithelial lesion in the lower esophagus, further complicated by ulcer formation. Biopsy did not reveal any malignant findings. On the eighth day of admission, the patient experienced substantial hematemesis with vital signs indicative of shock. Emergency EGD was performed, which revealed life-threatening bleeding in the lower esophagus. Contrast-enhanced CT revealed an aortoesophageal fistula with massive hematemesis, after which the patient died. An autopsy revealed perforation of the PAU into the esophagus without aortic dissection or a true aneurysm.
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页码：815 / 821
页数：6
相关论文
共 64 条
  • [1] Stanson AW(1986)Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations Ann Vasc Surg 1 15-23
  • [2] Kazmier FJ(1998)Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J Vasc Surg 27 1006-1015
  • [3] Hollier LH(2012)Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease J Vasc Surg 55 10-15
  • [4] Coady MA(1999)Pathologic variants of thoracic aortic dissections. Penetrating atherosclerotic ulcers and intramural hematomas Cardiol Clin. 17 637-657
  • [5] Rizzo JA(2004)penetrating atherosclerotic ulcer of the descending thoracic aorta and arch J Thorac Cardiovasc Surg 127 1393-1399
  • [6] Hammond GL(2012)Abdominal aortic disease caused by penetrating atherosclerotic ulcers Ann Vasc Dis 5 8-14
  • [7] Nathan DP(1914)Ueber Fremdkorpeverletzung des oesophagus mit aortenperforation Berl Klin Wochenschr 51 7-9
  • [8] Boonn W(1991)Aortoesophageal fistula: a comprehensive review of the literature Am J Med 91 279-287
  • [9] Lai E(2007)Intramural hematoma and penetrating atherosclerotic ulcer of the aorta Ann Thorac Surg 83 S835-S841
  • [10] Coady MA(2010)MDCT evaluation of acute aortic syndrome Radiol Clin N Am 48 67-83
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