Asian Journal of Case Reports in Surgery

Aorto-oesophageal fistula is a considerably rare but potentially fatal cause for upper gastro-intestinal bleeding. Mortality is high due to delayed diagnosis, delayed treatment due to limited facilities at the first contact health care centres and the possibility of re-bleeding even after successful initial treatment. The classic clinical picture has 3 symptoms termed Chiari’s triad which include mid thoracic pain, sentinel arterial haemorrhage and exsanguination. Diagnosis could be made by the clinical picture alone. Most investigations aimed at diagnosis have low specificity and sensitivity. The most frequently used test is upper GI endoscopy for diagnostic as well as treatment purposes. Definitive treatment is left thoracotomy and fistula repair. This is a case report of a 61-year-old male who died due to aorto-oesophageal fistula even after upper GI endoscopy had been performed.