title: Unusual cause of upper gastrointestinal bleed, when OGD could be fatal.
abstract: A 57-year-old man presented with chest pain, dyspnoea and coffee grounds emesis. He was haemodynamically stable without significant drop in haemoglobin. He suddenly developed cardiac arrest with wide complex tachycardia and became comatose. CT scan of the head revealed pneumocephalus and multiple infarcts. Given the recent history of radiofrequency ablation for atrial fibrillation, atrio-oesophageal fistula (AOF) was suspected. CT angiography of the thorax showed a 5 mm diverticulum on the posterior wall of the left atrium, also raising suspicion for AOF. The patient was taken to the operating room. An AOF was found and repaired. He did not have any further gastrointestinal bleeding. There was no neurological recovery at day 11 and life support was withdrawn per his family's request. This case highlights the importance of obtaining history of recent cardiac procedures in patients presenting with an upper gastrointestinal bleed. An oesophagogastroduodenoscopy in this patient could have been instantaneously deadly.
authors.affiliation: Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Raman
authors.initials: R
authors.lastname: Khehra
authors.affiliation: Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Satyanisth
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Aoun
authors.affiliation: Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Midian
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D003128:Coma / Q000503:physiopathology; D004937:Esophageal Fistula / Q000150:complications / Q000175:diagnosis*; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed