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J Thorac Cardiovasc Surg 2006;132:1482-1483
© 2006 The American Association for Thoracic Surgery

Brief Communication

Massive hematemesis in a child with undiagnosed aortic coarctation and mycotic aneurysm

^a Department of Cardiothoracic Surgery, Randwick, NSW, Australia
^b Department of Children’s Intensive Care, Randwick, NSW, Australia
^c Department of Pediatric Cardiac Anesthesia, Randwick, NSW, Australia
^d Department of Pediatric Surgery of Sydney Children’s Hospital, Randwick, NSW, Australia.

Received for publication August 1, 2006; accepted for publication August 7, 2006.

^_* Address for reprints: Peter Grant, MBBS (Hon), FRACS, MBA, Department of Cardiothoracic Surgery, Sydney Children’s Hospital, High Street, Randwick, NSW, Australia 2031. (Email: peter.grant@sesiahs.health.nsw.gov.au).

The first 20% of the full text of this article appears below.

Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal bleeding. Most cases are identified postmortem after an exsanguinating hemorrhage. We report a case of massive hematemesis caused by a ruptured mycotic aneurysm (MA) in a child with undiagnosed coarctation of the aorta, which was managed successfully. To our knowledge this is the first reported successful outcome of a ruptured MA in a de novo coarctation causing AEF in a child.

Clinical Summary

An 11-year-old boy presented with a 1-week history of fever, hematuria, and painful rash on the feet (Figure 1). He was provisionally treated for acute glomerulonephritis. Soon after admission, the boy demonstrated a massive hematemesis of 2 L and cardiac arrest. He was promptly resuscitated. His chest x-ray film showed deviation of the Ryles tube, indicative of a mediastinal mass (Figure 2, A). Endoscopy revealed a large clot in the upper third of the esophagus. Computed tomography of the thorax showed a hematoma around the . . . [Full Text of this Article]