Radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding.

Aortoesophageal fistula (AEF) is an unusual cause of massive upper gastrointestinal bleeding. Thoracic aortic aneurysm is the most common etiology of primary AEF followed by, respectively, foreign body ingestion, esophageal malignancy, and postsurgical fistulization. Radiation-induced damage to the great vessels is well recognized and some authors in the past have suggested that AEF may be caused by radiotherapy. However, previous case reports of radiation-induced AEF involved patients who received radiotherapy for esophageal carcinoma, and precise histopathologic differentiation between AEF secondary to esophageal malignancy and that induced by radiation was difficult. We present here the unique case of a patient with a non-esophageal carcinoma who received radiotherapy before the development of an AEF, thus providing further evidence for the role of radiation injury in the development of this condition. As well, we discuss current opinion regarding etiology, clinical presentation, diagnosis, and management of this entity.