Description
A 76-year-old man with a medical history of laryngeal cancer (T2N0M0), treated with radiotherapy and surgical excision (open partial laryngectomy) 20 years previously, and currently undergoing investigations for haematemesis, attended the emergency department after undergoing a week of recurrent epistaxis sometimes associated with hypotension and syncope. On examination, he had normal rhinoscopy findings. Blood tests revealed anaemia (haemoglobin 6 g/dL) with normal coagulation tests. After stabilising the patient with a blood transfusion, an oesophagogastroduodenoscopy was conducted, which revealed blood clots in the oesophagus, without a clear ulcer, wound or varices. The patient underwent an arteriography—the image showed a left carotid oesophageal fistula (figure 1, left).
Figure 1
Arteriography showing a left carotid oesophageal fistula (left), where three stents were inserted, resulting in complete fistula closure (right).
Causes of carotid-oesophageal fistula can result from arterial lesions; mediastinitis;1 a foreign body, such...
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