Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion

Aortoesophageal fistula (AEF) is a rare and mostly lethal cause of upper gastrointestinal bleeding in children. We report a successful outcome of surgical treatment after resuscitation of a girl aged 12 1/2 years with AEF as a complication of esophagitis caused by Dieffenbachia ingestion. The girl ate a leaf of Dieffenbachia picta in a suicidal attempt. After 5 weeks of medical treatment of esophagitis, small blood-stained vomitus and melena appeared. Within a few hours, it was followed by a massive gastrointestinal bleeding leading to exsanguination. The girl survived despite the pitfalls in clinical presentation and errors in diagnostic approach and treatment. Emergency exploration of cervical esophagus, followed by laparotomy and thoracotomy, was performed in attempt to find the source of bleeding and to control it. Aortoesophageal fistula was located between the ascending aorta near the origin of the brachiocephalic trunk and thoracic esophagus. Resection of the fistula led to prompt circulatory stabilization. The common houseplant, Dieffenbachia picta, causes edematous swelling of mucus membranes when chewed. Dieffenbachia-caused esophagitis is very rare and this etiology of AEF has not been reported in children.