Hemoptysis on Tuberculosis Sequelae: From the Physiopathology to the Endovascular Treatment

duodenoscopy (OGD) which revealed blood in the stomach (the neo-esophagus). The patient had a cardiac arrest before finding the source of the bleeding; hence, the OGD was aborted and cardiopulmonary resuscitation (CPR) commenced. He responded to one cycle of CPR and was intubated and fluid resuscitated. When hemodynamically stable, a computed tomography aortography (CTA) was performed, which demonstrated an aortoesophageal fistula (AEF) and no other aortic abnormality. A rapid decision was made to proceed with a thoracic endovascular repair of the aorta (TEVAR) limited to that segment of aorta. The procedure was successful. He had a follow-up OGD weeks later which was normal. Four months later, he represented to hospital with hypovolemic shock secondary to massive hematemesis. Again, a diagnosis of AEF was confirmed on CTA, which was just proximal to the previous aortic stent graft. He again had emergency TEVAR covering the descending aorta from the level just below the left subclavian artery to just proximal to the celiac artery, which was again lifesaving and uncomplicated. Three months later, a repeat OGD revealed a large gastric ulcer with a visible segment of aortic stent graft in the base. At this time, he reported no symptoms and had a normal full blood count. He was then referred urgently to have definitive upper gastrointestinal and descending aorta repair. He underwent a thoracotomy, left heart bypass, repair of aorto-gastric fistula with primary stomach repair, and thoracic and abdominal aorta replacement with a Dacron graft. He made good recovery. His stent graft culture grew Candida albicans and vancomycin-resistant enterococcus.