I’m going to explain three possible medical reasons that would cause bleeding from the mouth leading to death, like what happened on that Lufthansa flight.
It all comes down to how close the esophagus, or food pipe, is to big blood vessels like the carotid artery or aorta. And, what kind of disease might have made them connect.
The carotid and aorta have thick walls because blood going through them is under a lot of pressure. If the wall weakens, it might cause an aneurysm, which is like a balloon in the lining. Sometimes it can even make a wrong connection with the esophagus or the back of the throat. When the artery tears, lots of blood can come out of the nose and mouth and cause death.
Think of it like when your upstairs neighbor’s leaky pipe floods and makes a hole in your ceiling.
Possible Medical Causes
This can happen with head and neck cancer, where cancer, saliva, or radiation weakens the carotid artery. It’s called a carotid blowout in this case.
Similarly, an aortoesophageal fistula can also cause bleeding and death. It happens when an aneurysm in the chest’s aorta is caused by hardening arteries (atherosclerosis). The aorta needs a thick, elastic lining to handle the blood’s high pressure, but hardening arteries take away that elasticity.
A more common reason might be bleeding from esophageal varices, which is linked to liver disease from something like drinking too much alcohol. With this, the liver gets blocked, and blood can’t flow normally. Blood has to go through other veins, like the small ones around the esophagus. Because these veins weren’t meant to hold so much blood, they might break and cause heavy bleeding.
Can this happen out of the blue without warning?
Usually, these things don’t happen suddenly. There’s often a small but important bleed, called a sentinel bleed. It is usually a small but sudden bleed that stops or slows. What it really is, though, is a warning that a bigger potentially catastrophic bleed is coming.
The exact reason as to why will depend on the patient’s medical history as stated above.
Other proceeding symptoms might include chest pain, fast heart rate, feeling sick to your stomach, or black, tarry stools. These all indicate that a bleeding maybe happening but that you are not seeing it. Bleeding into the intestines or being transported through the intestines is what makes the stools black and tarry.
Any of these symptoms should prompt a person to go straight to the ER. In the ER, a good history, physical exam, blood work and imaging could help figure out the source of the bleeding and potentially even stop it.
At the very least, being in an optimal environment like the ER or hospital could give you more options if the large bleed were to happen.
Potential Treatment Options
The thing about something like a carotid blow out, aortoesophageal fistula, and ruptured esophageal varices is that because they are connected to very large and major blood vessels, the bleeding would be severe and the person will very quickly bleed out. Furthermore, because the bleeding is coming out of the mouth, the airway is also quickly compromised. So often an emergent tracheotomy has to be done and the mouth packed to help stop the bleeding. By putting pressure on the bleeding vessel, the blood loss can be minimized and the person may have a chance at repair. This obviously also depends on where the bleed is and if pressure can be applied to it.
If the patient’s airway can be secured and the bleeding slowed with pressure, then interventions such as endovascular repair can be done with interventional radiology or surgery. Even then it can be very tenuous.
In my career, I have had only once case in which a carotid blow out was able to walk out the door alive. This was mainly because the patient was in the hospital, had an iv and was lucky enough to have their blow out early in the morning before cases started, and literally when I was rounding on them. So the amount of time from a code being called, to an emergent tracheostomy being placed and mouth packed and transport to the endovascular suite was incredibly short.
The moral to the story is, if someone can go to the ER when they first notice these signs, there might be a way to help them. Sadly, though, many times even this is not enough.
