Acute bacterial aortitis resulting in an aortoesophageal fistula. A fatal complication of untreated esophageal carcinoma.

Exsanguination in a case of esophageal carcinoma resulted from an aortoesophageal fistula. The squamous carcinoma was undiagnosed clinically and was untreated. Ulceration of the carcinoma gave rise to mediastinitis and an abscess containing necrotic tumor and bacteria. Infection spread from the abscess to the adjacent aorta, producing focal bacterial aortitis, necrosis of the aortic media, and aortic perforation. A fistula was thus established between the aorta, the abscess cavity, and the esophagus. Terminally, the patient had a large hematemesis, and massive hemorrhage acutely distended the stomach which ruptured to produce a large hemoperitoneum.