Left atrio-esophageal fistula of a possibly iatrogenic aetiology

•Left atrio-esophageal fistula is a very rare complication of medicial procedures.•Left atrio-esophageal fistula has three possible iatrogenic causes.•Left atrio-esophageal fistula is very difficult to diagnose.•Simultaneous perforation of the cardiac and esophageal wall is life threatening.

The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube.