Clinical Practice and Cases in Emergency Medicine

Introduction: Aortoesophageal fistula is a rare but life-threatening hemorrhagic complication of thoracic endovascular aortic repair. Without intervention, mortality approaches 100%. Our case highlights the utility of using an esophageal-gastric balloon tamponade device for hemostasis.

Case Report: We report the case of a 70-year-old man who presented after a sentinel episode of hematemesis six days after thoracic endovascular aortic repair. Shortly after admission, the patient developed massive hematemesis and hemorrhagic shock from an aortoesophageal fistula. Hemorrhage was temporarily controlled via bedside placement of a Minnesota tube, a type of balloon tamponade device, by two emergency medicine and critical care physicians, allowing for hemostasis, resuscitation, and definitive diagnosis with esophagogastroduodenoscopy. The device successfully bridged the patient to the operating room, where he underwent definitive endovascular control of the hemorrhage and repair of the aortoesophageal fistula.

Conclusion: Our case highlights the utility and pragmatism of using a balloon tamponade device for massive hematemesis in nonvariceal hemorrhage. It also supports the placement of the device for non-variceal hemorrhage by nonspecialists, including critical care and emergency physicians.