title: Right hemothorax: An unusual presentation of a Barrett's ulcer perforation.
abstract: BACKGROUND
  Despite improvements in detection and surgical techniques perforation of the esophagus are lifethreatening. In this case report a rare presentation esophageal perforation due to Barrett's ulceration into an aortic vessel is described.
  
  
  METHODS
  We report a 42 year old man with known Barrett's esophagus presenting with abdominal pain. Further investigations showed an active intrathoracal hemorrhage due to esophageal perforation at exactly the same site of the known Barret's ulcer one year before. Thoracotomy with evacuation of blood was performed and an aortic branch as bleeding focus was found.
  
  
  CONCLUSIONS
  Hemothorax due to esophageal perforation of a benign Barrett's ulcer is rare. The diagnosis of aortoesophageal fistula's can be complicated and its presentation is frequently unspecific and is simply confused with other disorders. Acute thoracotomy is necessary and choice of closure depends on the cause and size of the perforation.
  
  
  CONCLUSIONS
  This case illustrates the need for maintaining a wide-ranging view of potential casus of hemothorax. The key to survival in patients with aorto-esophageal fistula is maintaining awareness of the condition to allow early diagnosis and operative management of this treatable lesion.
authors.affiliation: The Department of Surgery, Gelderse Vallei Hospital Ede, The Netherlands. Electronic address: voldersjh@gmail.com.
authors.forename: J H
authors.initials: JH
authors.lastname: Volders
authors.forename: B
authors.initials: B
authors.lastname: Witteman
authors.forename: A H
authors.initials: AH
authors.lastname: Mulder
authors.forename: A
authors.initials: A
authors.lastname: Bosch
authors.forename: Ph M
authors.initials: PM
authors.lastname: Kruyt