Prezentare de caz Moarte subit prin hemoragie intern ntr-un caz

de fistul aorto-esofagian nediagnosticat

G. Ilie, D. Priscaru, I. Mohorea

1.Serviciul Judetean de Medicin Legal Brila

2.Spitalul Judetean De Urgent Braila
3.Facultatea de Medicin ,, Dunrea de Jos Galai

Introducere:
Fistula aorto-esofagian a fost descris pentru prima dat n 1818 de ctre Dubrueil, chirurg n
marina francez care a ngrijit un marinar ce prezenta durei toracice i hematemez dup ingestia unui corp
strin (os de pete). In ziua a 5-a de la ingestie pacientul prezint o hematemez masiv n urma creia
decedeaz, fistula aorto-esofagian fiind confirmat necroptic.
Chiari a descris sindromul fistulei aorto-esofagiane ca o durere iradiat n spate, urmat de o
hemoragie semnal, apoi un interval liber, urmat de exsanguinare la cteva ore sau zile de la debut.
Material i metod:
Pacientul nostru s-a prezentat la camera de gard cu durere toracic posterioar, hematemez i
melen, rectoragii, hipotensiune, paloare, tahicardie. Se instituie internarea n ATI pentru reechilibrare i
investigaii suplimentare pentru decelarea cauzei sngerrii. Endoscopia eviden iaz la nivelul esofagului pe
faa posterioar o formaiune protruziv, frabil cu diametrul aprox. 1cm. La scurt timp pacientul moare
prin oc hemorgic.
La autopsie peretele esofagian prezenta o ulcera ie profund cu fibroz extensiv cuprinznd
ntreaga grosime a peretelui cu extindere la nivelul peretelui aortic. Leziunea ulcerativ esofagiana are
dimensiuni de 1,5x1,5x0,5 cm avnd corespondent traiect fistulos ntre leziunea esofagian i partea
superioar a aortei descendente.
Concluzii:
Fistula aorto-esofagian este o afeciune grav cu prodroame greu de interpretat, rar ntlnit n
practica curent cu evoluie rapid spre exitus.
Diagnosticarea corect i la timp a fistulei poate constitui o ans la via , func ie de cauza care a
generat dezvoltarea acesteia.

Case report- Sudden death after internal hemorrhage in a case of aorto-

esophageal fistula
Brila Departament of Legal Medicine
Regional Hospital Brila
Faculty of Medicine, Dunrea de Jos, University of Galai

Keywards: hemorragic shock, aorto-esophageal fistula

Introduction:
Aorto-esophageal fistula was first described in 1818 by Dubrueil, French navy surgeon who treated a
sailor with thoracic pain and haematemesis after ingestion of a foreign body (fishbone). In the 5th day of
ingestion, the pacient presents a massive haematemesis and after that, he died. Aorto-esophageal fistula was
confirmed on autopsy.
Chiari first describes the aorto-esophageal fistula syndrome as a thoracic pain irradiated in the
back, followed by a ,,signal hemorrhage, then a symptom-free interval followed by exanguination a few
hours later.
Material and method:
Our patient was presented to the emergency room with thoracic pain, haematemesis and
haematochezia, hypotension, pallor, tachycardia. The patient was admitted to intensive care for specialized
treatment and further investigation to determine the cause of bleeding. Upper digestive tract endoscopy
highlights on the posterior wall of esophagus a protrusive brittle tumor with a central ulceration, about 1
centimetre diameter. Our patient dies shortly by hemorrhagic shock.
On autopsy, our patients esophagus shows a deep ulceration with extensive necrosis and fibrosis
involving the entire thickness of the esophageal wall, extending into the wall of aorta. The ulcerative lesion of
esophagus is measured to be 1,5 x 1.5 x 0.5 cm with a fistula tract between esophageal lesion and superior
part of descending aorta.
Conclusions:
Aorto-esophageal fistula is a serious illness whose onset is difficult to interpret, rarely seen in
practice, rapidly evolving to exitus.
Accurate and prompt diagnosis may give patients with aorto-esophageal fistula a chance at survival
depending on the cause, and on the technical capabilities available for treating it.