Life-threatening bleeding from arterial-oesophageal fistula following oesophagectomy.

Oesophageal carcinoma remains one of the most common forms of cancer. Resection in the form of oesophagectomy and gastric interposition remains the standard surgical treatment and is associated with a high rate of post-operative morbidity. We report a case of a 71-year old male who underwent successful Ivor-Lewis oesophageal resection and developed life-threatening haemorrhage 2 weeks post-op, attributed to an arterial-oesophageal fistula. The patient was transferred to a specialist ENT centre with ligation of branches of the carotid artery, but intermittent bleeding continued. Following transfer to a specialist oesophago-gastric unit, repeated angiography was required to image the point of bleeding, which was embolised via percutaneous technique. The etiology, presentation, diagnosis and management of arterial-oesophageal fistulae are discussed, along with review of existing reports of similar complications and treatment options. A multidisciplinary approach, along with timely and often repeated imaging, is required in the management of arterial-oesophageal fistulae.