Aorto-Esophageal fistula is a rare condition, causes 
excessive bleeding from the upper gastrointestinal tract and is 
associated with a high mortality. This case report 
demonstrates the presentation of a 63-year old female with a 
primary aorto-esophageal fistula, due to a ruptured thoracic 
aneurysm. She first presented with a sentinel haemorrhage, 
followed by a new bleeding several hours later. An earlier 
performed upper gastrointestinal endoscopy elsewhere, 
because of dysphasia, already mentioned an impression from 
a non pulsing compressive swelling. No further analysis was 
performed.
 At
 current
 presentation,
 she was 
hemodynamically instable, with mild haematemesis. After 
stabilising she was admitted to the Intensive Care unit; 
however, haematemesis worsened. An immediate Computed 
Tomography (CT) scan showed an Aorto-Esophageal Fistula 
(AEF), due to a ruptured thoracic aortic aneurysm. Emergent 
surgical treatment consisted of endovascular stent-graft of the 
thoracic aorta and a total thoracic esophagectomy combined 
with immediate esophago-gastrostomy. Unfortunately, the 
subsequent multi-organ failure was fatal. A critical view to 
the surgical approach is given, combined with a review of 
diagnostic and therapeutic options in aorto-esophageal 
fistulae. 

Keywords: Aortic aneurysm thoracic; Aortic rupture; 
Esophageal
 Fistula;
 Endovascular
Aortoesophageal Fistula; Haematemesis