{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:59:02Z","timestamp":1757627942414,"version":"3.44.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Gastric squamous cell carcinoma (GSCC) arising within a gastric conduit is an exceedingly rare phenomenon, and its presentation as a gastro-aortic fistula has never been documented. This case highlights the diagnostic challenges and life-threatening potential of delayed aortoenteric complications after esophagectomy, and underscores the evolving role of endovascular therapy in emergent hemorrhage control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient concerns and clinical findings<\/jats:title><jats:p>A 75-year-old male presented with 6 h of recurrent, high-volume hematemesis and presyncope. On arrival, he was hypotensive (74\/50 mmHg), tachycardic, and profoundly anemic (hemoglobin 64 g\/L). Physical examination revealed marked conjunctival pallor but a soft, non-tender abdomen without signs of portal hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Diagnosis, interventions, and outcomes<\/jats:title><jats:p>Emergent computed tomography angiography demonstrated contrast extravasation from the posterior wall of the gastric conduit into the descending thoracic aorta. Digital subtraction angiography confirmed a focal gastro-aortic fistula at the T6 level. Under angiographic guidance, thoracic endovascular aortic repair (TEVAR) was performed using a COOK ZTEG-2PT-30-200 covered stent graft, achieving immediate hemostasis. The patient received massive transfusion support (22 units packed red cells, 8 units cryoprecipitate, 2,000 ml fresh frozen plasma) alongside proton pump inhibitors and somatostatin. Two days post-repair, endoscopic biopsy of the conduit ulcer edge confirmed squamous cell carcinoma. The patient recovered without further bleeding and was discharged day 10 in stable condition. A multidisciplinary tumor board recommended adjuvant chemoradiotherapy. The patient and family opted for palliative care following oncologic consultation due to the advanced disease stage and overall clinical context.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In late post-esophagectomy patients presenting with massive upper gastrointestinal bleeding, high clinical suspicion for arterioenteric fistula is warranted. Computed tomography angiography and DSA should precede endoscopy in hemodynamically unstable patients. TEVAR offers a minimally invasive, rapid means of hemorrhage control, serving as a critical bridge to definitive cancer management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1624035","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:24:26Z","timestamp":1757481866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Squamous cell carcinoma-induced gastric conduit-thoracic aorta fistula presenting with massive hematemesis 4 years after radical esophagectomy: a CARE guidelines-compliant case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Conghua","family":"Song","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianyang","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiyuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaomei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1419923","DOI":"10.3389\/fonc.2024.1419923","article-title":"Squamous cell carcinoma of the stomach: focus on a heterogeneous disease at diagnosis. 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