Abstract
A 70-year-old male admitted to an emergency ward was examined for signs of sepsis. He complained of suffering from epigastralgia, food stagnation sensations, absence of appetite, and severe weight loss for several months.
Elevation of inflammatory markers, dehydration, an ion imbalance, and microcytic anemia were found. The cause of sepsis was not revealed by abdominal ultrasonography, abdominal and chest X-rays, and abdominal, thoracic, and pelvic computer tomography.
Transesophageal echocardiography was planned to rule out infectious endocarditis; however, gastroscopy was performed as a first-line examination. Blood was observed in the distal esophagus and stomach throughout this procedure.
Refractory shock occurred during the examination, followed by unsuccessful cardiopulmonary resuscitation. Esophageal adenocarcinoma with an atrioesophageal fistula was found on autopsy, which was the cause of endocarditis and septic emboli in the systemic circulation.
Installation of the nasogastric probe and air insufflation at the beginning of the gastroscopic examination likely caused the release of masses that originally filled the fistula, leading to massive bleeding and refractory hemorrhagic shock.