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Joseph KR, Singh J, Chin R, Lee A, Oborska Y, Mayorchak Y. A novel approach to surviving an acute aorto-oesophageal fistula: A case report. Int J Surg Case Rep 2024; 121:110035. [PMID: 39013248 PMCID: PMC11304060 DOI: 10.1016/j.ijscr.2024.110035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute aorto-oesophageal fistula poses a significant mortality risk, requiring immediate and decisive medical intervention. This report highlights the critical need for innovation in emergency surgical responses. CASE PRESENTATION A 57-year-old male, with a history of aortic repair, presented with chronic anaemia and dysphagia. He suffered a cardiac arrest from massive hematemesis during surgery for an infected thoracic hematoma. Lacking a Stengsten-Blackmore tube, a 26Fr Foley catheter was used to control the bleeding. This measure stabilized the patient enough for a definitive endovascular repair with aortic stents, which successfully managed the bleeding. CLINICAL DISCUSSION The treatment objectives for this condition include initial control of oesophageal bleeding, followed by endovascular management to further control the bleeding, subsequently releasing the oesophageal control, and ultimately preventing infection through the administration of intravenous antibiotics. CONCLUSION This case illustrates the importance of adaptability and the use of unconventional methods in emergency situations, demonstrating that innovative solutions can be lifesaving in critical surgical emergencies.
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Le PTV, Nguyen HT, Lam VS, Nguyen HD, Chu TAT. Thoracic Endovascular Aortic Repair for an Aortoesophageal Fistula Caused by Esophageal Cancer: A Case Report and Literature Review. Cureus 2024; 16:e64243. [PMID: 39130999 PMCID: PMC11315445 DOI: 10.7759/cureus.64243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Aortoesophageal fistula (AEF) is an uncommon complication of esophageal cancer and can be extremely fatal if left untreated. Compared to open repair, thoracic endovascular aortic repair (TEVAR), a less invasive technique, is the initial recommended treatment in cases of hemorrhagic shock secondary to AEF, as this procedure showed a favorable outcome in controlling the overt bleeding. Here, we present a case of a patient with a history of stage IV esophageal cancer being treated with chemotherapy and an esophageal stent due to a previous tracheoesophageal fistula who presented to the emergency room due to severe gastroesophageal bleeding and hemorrhagic shock. A CT angiography of the chest revealed an AEF. The patient was subsequently resuscitated and treated with TEVAR. After the procedure, the hemorrhage was managed, and the patient was discharged with palliative radiation therapy. However, after one month, the patient had a major gastrointestinal hemorrhage, which caused her death. This example indicates the necessity of early detection and surgical intervention in AEF patients with unstable hemodynamics who have underlying unresectable esophageal cancer and chemotherapy. TEVAR should be conducted as soon as possible before the open surgery to achieve the best outcome for patients.
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Affiliation(s)
- Pham Thao Vy Le
- Cardiovascular Research Laboratories, Methodist Hospital, Merrillville, USA
| | | | - Vinh Sieu Lam
- Cardiovascular Research Laboratories, Methodist Hospital, Merrillville, USA
| | - Hieu D Nguyen
- Cardiovascular Research Laboratories, Methodist Hospital, Merrillville, USA
| | - Thi Anh Thao Chu
- Internal Medicine, Yavapai Regional Medical Center, Prescott, USA
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3
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Uemura H, Matsue H, Suehiro Y, Nakagawa T, Satoh A, Teshima Y, Bungo M, Satoh H. Surgical repair of an aortoesophageal fistula after salvage thoracic endovascular aortic repair: a case report. J Med Case Rep 2024; 18:285. [PMID: 38902817 PMCID: PMC11191166 DOI: 10.1186/s13256-024-04605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
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Affiliation(s)
- Hisashi Uemura
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Hajime Matsue
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Yasuo Suehiro
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Takaya Nakagawa
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Ayaka Satoh
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan
| | - Yoshio Teshima
- Department of Cardiovascular Surgery, Hyogo Medical University, Hyogo, Japan
| | - Masashi Bungo
- Department of Cardiovascular Surgery, Hyogo Medical University, Hyogo, Japan
| | - Hisashi Satoh
- Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho 2-1, Takarazuka, Hyogo, Japan.
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Mills A, Tanaka A, Dawson A, Hetz R, Smith H, Lopez M, Safi H, Estrera A. Management of aortoesophageal fistula primarily using esophageal preservation. JTCVS OPEN 2024; 19:31-38. [PMID: 39015446 PMCID: PMC11247201 DOI: 10.1016/j.xjon.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 07/18/2024]
Abstract
Objective Aortoesophageal fistula is a rare, life-threatening condition. There is no consensus regarding the surgical management of the esophagus in this condition. Methods We retrospectively evaluated 13 patients diagnosed with aortoesophageal fistulas at a single institution from 2003 to 2021. Descriptive statistics were used to analyze patient characteristics, operative characteristics, and patient outcomes. Kaplan-Meier survival analysis was performed. Results Patients' mean age was 63.5 years, and 6 (46.2%) were female. The most common presenting symptoms were hemoptysis/hematemesis (69.2%), chest/back pain (46.2%), and fever (38.5%). Twelve patients (92.3%) had a history of aortic procedures. The median time between the index operation and repair of the secondary aortoesophageal fistula in the 12 patients was 5 months. The index operation was a thoracic endovascular aortic repair in 10 of 12 patients (83.3%). Eleven patients (84.6%) underwent primary esophageal repair with flap coverage (omentum or muscle). One of these patients needed an esophagectomy within 1 year. The primary surgical management of the aorta was graft excision and replacement, aside from 1 patient who underwent primary repair. The 30-day survival was 69.2%, and 1-year and 5-year survivals were 31.7%. There were no recurrent infections at the esophageal fistula site. Conclusions Aortoesophageal fistula remains a rare condition, but its case numbers have increased with thoracic endovascular aortic repair. It continues to be a difficult condition to manage and has a high fatality rate. Esophageal-preserving surgery may be a safe and less-invasive option for patients with a small defect.
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Affiliation(s)
- Alexander Mills
- Department of General Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Akiko Tanaka
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Ashley Dawson
- Department of General Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Robert Hetz
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Holly Smith
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Michael Lopez
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Hazim Safi
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
| | - Anthony Estrera
- Department of Cardiovascular and Thoracic Surgery, McGovern Medical School at UTHealth Houston, Houston, Tex
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Saisho K, Mori N, Nakagawa M, Nakamura E, Tanaka Y, Kaku H, Tanaka Y, Isobe T, Otsuka H, Sudo T, Sakai H, Ishibashi N, Hisaka T, Tayama E, Fujita F. Aortoesophageal fistula due to esophageal cancer: a case report of successful management. Surg Case Rep 2024; 10:88. [PMID: 38630370 PMCID: PMC11024079 DOI: 10.1186/s40792-024-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but potentially life-threatening condition. The best treatment for the AEF due to esophageal carcinoma is still unresolved. Here, we report a rare case of AEF caused by esophageal cancer, that was successfully treated with emergency thoracic endovascular aortic repair (TEVAR), followed by esophagectomy and gastric tube reconstruction. CASE PRESENTATION A 64-year-old man presented with loss of consciousness and hypotension during chemoradiotherapy for advanced esophageal cancer. Enhanced computed tomography showed extravasation from the descending aorta into the esophagus at the tumor site. We performed emergency TEVAR for the AEF, which stabilized the hemodynamics. We then performed thoracoscopic subtotal esophagectomy on day 4 after TEVAR to prevent graft infection, followed by gastric tube reconstruction on day 30 after TEVAR. At 9 months after the onset of AEF, the patient continues to receive outpatient chemotherapy and leads a normal daily life. CONCLUSION TEVAR is a useful hemostatic procedure for AEF. If the patient is in good condition and can continue treatment for esophageal cancer, esophagectomy and reconstruction after TEVAR should be performed to prevent graft infection and maintain quality of life.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiji Nakamura
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yu Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideaki Kaku
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuya Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoya Sudo
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahi Machi, Kurume, Fukuoka, 830-0011, Japan
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Rustemov D, Bilal R, Tukinov R, Nekessov A, Dzhenalaev D, Ermeshev E, Mukhamedov Z, Mustafinov D, Utebaliev R, Sakuov Z, Kaliev B. Case Report: Unique management strategy for rare case of esophageal foreign body. Front Surg 2024; 11:1370876. [PMID: 38505410 PMCID: PMC10948502 DOI: 10.3389/fsurg.2024.1370876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
Background Foreign bodies that enter the esophagus can cause serious complications that may require extensive surgical intervention, including open surgery. The treatment method depends on the location, size, configuration, and number of foreign bodies in the esophagus, but to date, the best method to remove foreign bodies from the esophagus remains uncertain. Foreign bodies which can damage the walls of esophagus varies from bones and bone fragments, to metallic objects and batteries. In this article, we present a rare case of a "fish bone" penetrating through the esophagus walls and directly punctured the aorta, forming a post-traumatic saccular pseudoaneurysm of the descending thoracic aorta, which was successfully treated with endovascular stent placement to the aorta and with endoscopic foreign body removal. Case summary We reported a case of a 16-year-old male with a 6-day history of chest pain after consuming fish. As result of immediate test in regional hospital using oral flexible esophagogastroduodenoscopy abnormalities were not reported. Due to persistence of beforementioned symptoms, a fiberoptic esophagogastroduodenoscopy was performed 3 days later, revealing a 1.5-2.0 cm long altered area with contact bleeding 33.0 cm from the incisors, but no visualization of any foreign body. Computed tomography revealed a fish bone that had completely passed through walls of the esophagus and punctured the aortic wall, forming an aneurysm. Patient was urgently hospitalized by air ambulance to our hospital for high-specialized medical intervention after 6 days. After the endovascular placement of a stent graft, the fish bone was successfully removed by endoscopic intervention. 12 months follow up showed no abnormalities. Conclusion Endoscopic removal of foreign bodies in the esophagus and extracting a foreign body after thoracic endovascular aortic stent may be a feasible option for some cases.
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Affiliation(s)
- Dastan Rustemov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Bilal
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Ruslan Tukinov
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Adilzhan Nekessov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Damir Dzhenalaev
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Erbulat Ermeshev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zarip Mukhamedov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Dulat Mustafinov
- Clinical Academic Department of Pediatric Surgery, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Ruslan Utebaliev
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Zhenis Sakuov
- Resuscitation and Intensive Care Unit, Clinical Academic Department Pediatric Anesthesiology, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
| | - Baurzhan Kaliev
- Clinical Academic Department of Radiology and Nuclear Medicine, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
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Lu SW, Niu KY, Pai CP, Lin SH, Chen CB, Lo YT, Lee YC, Seak CJ, Yen CC. Novel Prediction Score for Arterial-Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study. Cancers (Basel) 2024; 16:804. [PMID: 38398195 PMCID: PMC10886662 DOI: 10.3390/cancers16040804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To develop and internally validate a novel prediction score to predict the occurrence of arterial-esophageal fistula (AEF) in esophageal cancer bleeding. METHODS This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability. RESULTS A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n = 155) and a validation cohort (n = 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level >1.2 mg/dL, prothrombin time >13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82-0.98) and 0.82 (95% CI 0.72-0.92), respectively. CONCLUSIONS By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.
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Affiliation(s)
- Sz-Wei Lu
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
- Department of Emergency Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei 105, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (K.-Y.N.); (Y.-C.L.)
| | - Chu-Pin Pai
- Division of Thoracic Surgery, Department of Surgery, Lotung Poh-Ai Hospital, Yilan 265, Taiwan;
| | - Shih-Hua Lin
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan;
| | - Chen-Bin Chen
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (C.-B.C.); (C.-J.S.)
| | - Yu-Tai Lo
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Yi-Chih Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (K.-Y.N.); (Y.-C.L.)
| | - Chen-June Seak
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (C.-B.C.); (C.-J.S.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (K.-Y.N.); (Y.-C.L.)
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (C.-B.C.); (C.-J.S.)
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Li J, Hu Y, Liu W, Tang J, Zhu S, Zeng C. A successful endovascular aortic repair of aortoesophageal fistula following esophagectomy: a case report and literature review. J Cardiothorac Surg 2024; 19:70. [PMID: 38326831 PMCID: PMC10848545 DOI: 10.1186/s13019-024-02540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. CASE PRESENTATION Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. CONCLUSIONS In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.
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Affiliation(s)
- Jina Li
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yan Hu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wenliang Liu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jingqun Tang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Song Zhu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chao Zeng
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Yokoe T, Toiyama Y, Ichikawa T, Uratani R, Imaoka H, Yasuda H, Morimoto Y, Fujikawa H, Okugawa Y, Okita Y, Yoshiyama S, Ohi M. Successful management following combined thoracic endovascular aortic repair and minimally invasive esophagectomy for primary aortoesophageal fistula: A case report. Asian J Endosc Surg 2024; 17:e13249. [PMID: 37845781 DOI: 10.1111/ases.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023]
Abstract
Aortoesophageal fistula (AEF) is a rare but life-threatening pathology. We report a case of a primary AEF that was successfully managed with temporary thoracic endovascular aortic repair (TEVAR) and esophagectomy with video-assisted thoracoscopic surgery. A 73-year-old man was transferred to the emergency department with a complaint of hematemesis. A computed tomography scan identified an AEF due to aortic aneurysm. We placed a stent using TEVAR for the purpose of hemodynamic stasis, and the operation was performed 23 h after admission. Right video-assisted thoracoscopic esophagectomy (VATS-E) was chosen, and a cervical esophagostomy and a feeding gastrostomy tube was constructed. Infection had been effectively controlled postoperatively. Four months after the first operation, we performed esophageal reconstruction. At the 70-month follow-up examination, the patient had no signs of mediastinitis. VATS-E immediately after hemostabilization by TEVAR is useful management for primary AEF.
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Affiliation(s)
- Takeshi Yokoe
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takashi Ichikawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Uratani
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroki Imaoka
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiromi Yasuda
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuki Morimoto
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroyuki Fujikawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshiki Okita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shigeyuki Yoshiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ohi
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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10
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Kimura Y, Nakamura K, Kojima D, Katayama T, Takarabe S, Kishikawa H, Sasaki A, Hisamatsu T, Nishida J. Life-threatening gastrointestinal bleeding caused by perforation of a penetrating atherosclerotic ulcer into the esophagus. Clin J Gastroenterol 2023; 16:815-821. [PMID: 37695416 DOI: 10.1007/s12328-023-01856-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
We present a case of life-threatening gastrointestinal bleeding caused by a penetrating atherosclerotic ulcer (PAU) that ruptured into the esophagus. A 65-year-old man presented with pyrexia and nausea. Contrast-enhanced computed tomography (CT) performed on admission revealed a hematoma between the lower esophagus and descending aorta due to a contained rupture of a PAU, which was undiagnosed at that time. Esophagogastroduodenoscopy (EGD) performed on the fifth day of admission revealed a subepithelial lesion in the lower esophagus, further complicated by ulcer formation. Biopsy did not reveal any malignant findings. On the eighth day of admission, the patient experienced substantial hematemesis with vital signs indicative of shock. Emergency EGD was performed, which revealed life-threatening bleeding in the lower esophagus. Contrast-enhanced CT revealed an aortoesophageal fistula with massive hematemesis, after which the patient died. An autopsy revealed perforation of the PAU into the esophagus without aortic dissection or a true aneurysm.Patients with atherosclerosis who develop recent-onset gastrointestinal symptoms, progressive anemia, and/or periaortic lesions should be carefully evaluated using contrast-enhanced CT, and PAU should be considered in the differential diagnosis.
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Affiliation(s)
- Yoko Kimura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Kenji Nakamura
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Daiki Kojima
- Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Tadashi Katayama
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Sakiko Takarabe
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Hiroshi Kishikawa
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Aya Sasaki
- Department of Clinical Laboratory, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
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11
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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12
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Brotherton T, Numan L, Al-Kaade S. Timely Endoscopic Recognition of Aortoesophageal Fistula With Successful Treatment. ACG Case Rep J 2023; 10:e01123. [PMID: 37547481 PMCID: PMC10402988 DOI: 10.14309/crj.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Aortoesophageal fistula (AEF) is a devastating cause of upper gastrointestinal bleeding that occurs because of pathologic communication of the esophagus with the aorta. Bleeding AEF has high mortality even with appropriate interventions. In this study, we present a case of a 52-year-old man who presented with hematemesis, which was found to be due to an actively bleeding AEF. Prompt identification of the fistula led to multiple endoscopic interventions that stabilized the patient and allowed him to undergo emergent endovascular aortic stent placement with successful bleeding control.
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Affiliation(s)
- Tim Brotherton
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO
| | - Laith Numan
- Department of Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO
| | - Samer Al-Kaade
- Department of Gastroenterology, Mercy Hospital South, Saint Louis, MO
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13
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Pranavan S, Mayorathan U, Munasinghe BM. A fatal aorto-oesophageal fistula due to a mutton bone: A case report. Int J Surg Case Rep 2023; 108:108478. [PMID: 37421771 PMCID: PMC10382798 DOI: 10.1016/j.ijscr.2023.108478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE OF THE CASE Aorto-oesophageal fistula (AEF) following foreign body ingestion is rare and conservative management is always fatal. The delayed presentation further confounds poor outcomes. PRESENTATION OF CASE A 46-year-old South-Asian woman presented with pain and difficulty in swallowing following ingestion of a mutton-containing meal. The patient refused urgent upper GI endoscopy and was initially managed conservatively on the basis of the resolution of symptoms and hemodynamic stability and was discharged home. On review a week later, the patient did not consent to a UGIE. She presented the next day with a severe upper GI bleed. Due to profuse haemorrhage, a bleeding point could not be identified, and she suffered a cardiac arrest. Attempts at resuscitation were unsuccessful. The autopsy revealed an AEF caused by a sharp mutton bone lodged in the lower oesophagus. CLINICAL DISCUSSION High-risk food bolus impactions such as the ones caused by sharp objects need urgent endoscopy to confirm the position and extraction if safe. AEF occurs with time and could result in massive haemorrhage and mediastinitis. Endoscopic stenting, thoracoscopic surgery, and open repair are methods of emergent and definite management that still carry significant mortality. CONCLUSION Management of AEF requires early diagnosis with a high index of suspicion, endoscopic and CT-based angiography studies, and surgical interventions tailored to patients based on the available expertise. High-risk patients should be similarly educated on the probable complications and the symptomatology.
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Affiliation(s)
| | | | - B M Munasinghe
- Department of Anaesthesiology and Intensive Care, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK.
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14
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Hafezeftekhari S, Khoroushi F, Bozorgi H. Aortoesophageal fistula complicated by mycotic aneurysm secondary to endoscopic procedures: A case report. Clin Case Rep 2023; 11:e7690. [PMID: 37469368 PMCID: PMC10352552 DOI: 10.1002/ccr3.7690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal bleeding that often receives little attention in the emergency department. The classic presentation includes the Chiari triad of central chest pain, sentinel arterial bleeding, and subsequent evacuation after an asymptomatic period. For patients suspected of having AEF, a CT scan with IV contrast is the preferred diagnostic modality. In our patient, the presence of an aortic wall outpouching, ectopic gas, periaortic fat stranding, and leukocytosis, even in the absence of fever and positive blood culture, suggested mycotic aneurysm with AEF. The unique aspect of this case report is the occurrence of AEF as a rare complication of endoscopic procedures, which should be considered. Treatment options for AEF include surgery and thoracic endovascular aortic repair (TEVAR). TEVAR is a good option for stabilizing the patient's condition and reducing mortality in the short term. Once the patient's condition is suitable for AEF repair surgery, surgical intervention can be performed.
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Affiliation(s)
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Hossein Bozorgi
- Department of Radiology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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15
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Rey Chaves CE, Rojas S, Rosso JD, Peláez M, Sánchez EF, Hernández Rodríguez OG. Aortoesophageal fistulae following TEVAR: Case report and literature review. Int J Surg Case Rep 2023; 106:108126. [PMID: 37058806 PMCID: PMC10130615 DOI: 10.1016/j.ijscr.2023.108126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION Aortoesophageal fistulae are an uncommon pathology, primarily due to the aortic pathology in more than 50 % of the cases, followed by foreign body ingestion, and advanced malignancies. Recently it is recognized after surgical management of thoracic aortic pathologies either open or endovascular, with increased rates of morbidity and mortality. PRESENTATION OF THE CASE We present a 62-year-old male patient with a previous history of thoracic endovascular aortic repair, who enters the emergency room with gastrointestinal bleeding and clinical signs of infection. Positive blood cultures, and tomographic signs include prosthetic gas, with endoscopic findings of aortoesophageal fistulae. Aggressive surgical management was performed including esophageal resection and gastrointestinal exclusion. Bleeding control was reached in the early postoperative period, nevertheless despite multidisciplinary management, the patient died 8 days after surgery. CLINICAL DISCUSSION Aortoesophageal fistulae, remains to be an uncommon complication either of thoracic aortic aneurysm or after endovascular treatment of aortic aneurysm; with high rates of morbidity and mortality, should be suspected in every case with upper gastrointestinal bleeding in the context of a patient with aortic disease. Non-surgical management should be avoided due to the high risk of complications and mortality, aggressive management needs to be considered in each case according to clinical condition of the patient. CONCLUSION Aortoesophageal fistulae remain an uncommon complication after TEVAR, with increased mortality and morbidity rates after complete treatment. Conservative management should be avoided to achieve bleeding control and prevent the extension of the infection.
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Affiliation(s)
- Carlos Eduardo Rey Chaves
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá - Colombia.
| | - Santiago Rojas
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina. Bogotá - Colombia
| | - J D Rosso
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Mauricio Peláez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía de Tórax, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Elio Fabio Sánchez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía General y Cirugía Oncológica. Coordinador Unidad Cirugía Oncológica. Profesor asistente Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
| | - Oscar Geovanny Hernández Rodríguez
- Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia; Cirugía vascular periférica, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio. Bogotá - Colombia
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16
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Crespo Álvarez E, Giménez Francés C, Navarro García I, Perán Fernández C, Gijón Román C, Gómez Molina B, Casado García V, Vázquez Rojas JL. Aortoesophageal fistula as a fatal complication of esophageal perforation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:211-212. [PMID: 36779461 DOI: 10.17235/reed.2023.9479/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Aortoesophageal fistula is a very rare cause of upper gastrointestinal bleeding, however its interest lies in the high mortality rate associated with it. Due to this, early diagnosis and treatment of this entity is essential to increase survival. The typical symptoms known as the Chiari´s triad are only present in 45% of reported cases. We present the case of a patient with upper gastrointestinal bleeding due to an aortoesophageal fistula as well as the importance of endoscopic use for its differential diagnosis.
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Affiliation(s)
- Elena Crespo Álvarez
- Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, España
| | - Clara Giménez Francés
- Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, España
| | | | | | - Cecilia Gijón Román
- Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía
| | - Beatriz Gómez Molina
- Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía
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17
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Wong AC, Chou YM, Goh ZNL, Chang KF, Seak CJ. Case report: Aortoesophageal fistula-an extremely rare but life-threatening cardiovascular cause of hematemesis. Front Cardiovasc Med 2023; 10:1123305. [PMID: 37153464 PMCID: PMC10157070 DOI: 10.3389/fcvm.2023.1123305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Aortoesophageal fistula (AEF) is an extremely rare cardiovascular etiology of hematemesis and upper gastrointestinal bleeding. As such, its recognition and diagnosis are challenging and may be delayed when such patients present to the emergency department (ED). Without timely surgical intervention, AEF is almost always fatal. Awareness of AEF as a possible diagnosis and consequently early identification of these patients presenting to the ED are therefore crucial in optimizing clinical outcomes. We report a 45-year-old male presenting to the ED with the classical triad of an AEF (Chiari's triad)-midthoracic pain or dysphagia, a sentinel episode of minor hematemesis, then massive hematemesis with risk of exsanguination. The case report highlights the importance of considering the differential diagnosis of AEF when evaluating patients presenting to the ED with hematemesis, especially if they have predisposing risk factors such as prior aortic or esophageal surgeries, aortic aneurysms, or thoracic malignancies. Patients suspected of having AEF should be prioritized for early computed tomography angiography to expedite diagnosis and treatment.
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Affiliation(s)
- Alexis Ching Wong
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Yu-Mou Chou
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Zhong Ning Leonard Goh
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Kuang-Fu Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Correspondence: Chen-June Seak
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18
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Lu SW, Pai CP, Yang TH, Lu JX, Hsiao CH, Yen CC. Clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with upper gastrointestinal bleeding: a multicenter study. Front Oncol 2023; 13:1184710. [PMID: 37213275 PMCID: PMC10198378 DOI: 10.3389/fonc.2023.1184710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Esophageal cancer is a highly malignant neoplasm with poor prognosis. Of its patients, upper gastrointestinal bleeding (UGIB) is one of the most challenging and threatening conditions in the emergency department (ED). However, no previous studies have analyzed the etiologies and clinical outcomes in this specific population. This study aimed to identify the clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with UGIB. Methods This retrospective cohort study enrolled 249 adult patients with esophageal cancer presenting with UGIB in the ED. Patients was divided into the survivor and non-survivor groups, and their demographic information, medical history, comorbidities, laboratory parameters, and clinical findings were recorded. The factors associated with 30-day mortality were identified using Cox's proportional hazard model. Results Among the 249 patients in this study, 30-day mortality occurred in 47 patients (18.9%). The most common causes of UGIB were tumor ulcer (53.8%), followed by gastric/duodenal ulcer (14.5%), and arterial-esophageal fistula (AEF) (12.0%). Multivariate analyses indicated that underweight (HR = 2.02, p = 0.044), history of chronic kidney disease (HR = 6.39, p < 0.001), active bleeding (HR = 2.24, p = 0.039), AEF (HR = 2.23, p = 0.046), and metastatic lymph nodes (HR = 2.99, p = 0.021) were independent risk factors for 30-day mortality. Conclusions The most common cause of UGIB in esophageal cancer patients was tumor ulcer. AEF, accounting for 12% of UGIB in our study, is not an uncommon cause. Underweight, underlying chronic kidney disease, active bleeding, AEF, and tumor N stage > 0 were independent risk factors for 30-day mortality.
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Affiliation(s)
- Sz-Wei Lu
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Chu-Pin Pai
- Division of Thoracic Surgery, Department of Surgery, Luodong Poh-Ai Hospital, Ilan, Taiwan
| | - Ting-Hao Yang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Jian-Xun Lu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN, United States
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- *Correspondence: Chieh-Ching Yen,
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19
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Nana Sede Mbakop R, Shah J, Forlemu A, Gayam V, Bandaru P, Kumar V, Reddy M. Chicken Bone Ingestion Leads to Aortoesophageal Fistula With Catastrophic Bleeding. J Investig Med High Impact Case Rep 2023; 11:23247096231192818. [PMID: 37585743 PMCID: PMC10416653 DOI: 10.1177/23247096231192818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Aortoesophageal fistula (AEF) is an uncommon, but potentially fatal cause of upper gastrointestinal bleeding. Aortoesophageal fistulas caused by foreign body ingestion are rare but devastating. The classic clinical triad of AEF consists of mid-thoracic pain or dysphagia, a herald episode of hematemesis, followed by fatal exsanguination after a symptom-free period (Chiari's triad). Computed tomography angiography (CTA) is the preferred diagnostic tool for identifying AEF and is substantially more sensitive than upper endoscopy for detecting AEF. Endoscopy can detect AEF as it might show pulsatile blood, pulsatile mass, hematoma, or adherent blood clot in the esophagus, or a deep esophageal tear. However, endoscopy has a low sensitivity and may delay definitive treatment. Several management options for AEF have been suggested; however, the definitive treatment is surgery performed on the thoracic aorta and esophagus, including esophagectomy, surgical replacement of the thoracic aorta, thoracic endovascular aortic repair, or omental flap. We report a case of a 63-year-old man who presented with hematemesis 2 weeks after chicken bone ingestion.
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Affiliation(s)
| | - Jamil Shah
- The Brooklyn Hospital Center, Brooklyn, New York, USA
| | | | - Vijay Gayam
- The Brooklyn Hospital Center, Brooklyn, New York, USA
| | | | - Vikash Kumar
- The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Madhavi Reddy
- The Brooklyn Hospital Center, Brooklyn, New York, USA
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20
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Donato F, Boskoski I, Vincenzoni C, Montanari F, Tinelli G, Donati T, Tshomba Y. A New Mini-Invasive Approach for a Catastrophic Disease: Staged Endovascular and Endoscopic Treatment of Aorto-Esophageal Fistulas. J Pers Med 2022; 12:1735. [PMID: 36294876 PMCID: PMC9605668 DOI: 10.3390/jpm12101735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 08/10/2023] Open
Abstract
Aorto-esophageal fistula (AEF) is an uncommon but usually fatal disorder. Surgery with resection of an aneurysm and esophagus, in situ reconstruction of the descending aorta and omental flap installation offers the gold standard for the reduction of infections, but it is burdened by high intraoperative and perioperative mortality rates. We report our experience with a combined minimally invasive approach for the multi-stage treatment of three cases of aorto-esophageal fistula caused by thoracic aneurysm rupture. In all of the patients, the aneurysm was treated with thoracic endovascular aortic repair and the esophageal lesion was treated with esophageal endoprosthesis placement. According to our experience, the combined strategy of thoracic endovascular aortic repair (TEVAR) and esophageal less invasive endoscopic treatments represents an alternative solution in frail patients with high surgical risk.
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Affiliation(s)
- Federica Donato
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Vincenzoni
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Montanari
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Donati
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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21
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Naser ZJ, Lalka SG. “Endovascular repair of aorto-bronchial fistula three decades after open repair of traumatic aortic transection: A case report and 3-year follow up”. J Vasc Surg Cases Innov Tech 2022; 8:732-735. [DOI: 10.1016/j.jvscit.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
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22
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Vara S, Jayanthi NV, Gadhvi V, Thapar A. Total endoluminal repair of aorto-oesophageal fistula. BMJ Case Rep 2022; 15:e246539. [PMID: 35649625 PMCID: PMC9161096 DOI: 10.1136/bcr-2021-246539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially revealed profuse bleeding at 20cm from the incisors, initially treated with an oesophageal covered stent. Following ongoing haematemesis, a thoracic and abdominal CT angiogram demonstrated an aorto-oesophageal fistula, which was successfully treated with a thoracic endograft and left tube thoracostomy. The patient remains well to 1 year. This is the first case to demonstrate successful use of covered stents in both the aorta to stop exsanguination, as well as the oesophagus to prevent mediastinitis and avoid the need for thoracotomy and hypothermic circulatory arrest in a critically ill patient.
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Affiliation(s)
- Sarina Vara
- Mid and South Essex Vascular Unit, Mid and South Essex Hospitals NHS Foundation Trust, Basildon, Essex, UK
| | | | - Vijay Gadhvi
- Mid and South Essex Vascular Unit, Mid and South Essex Hospitals NHS Foundation Trust, Basildon, Essex, UK
| | - Ankur Thapar
- Mid and South Essex Vascular Unit, Mid and South Essex Hospitals NHS Foundation Trust, Basildon, Essex, UK
- Academic Section of Vascular Surgery, Imperial College London, London, London, UK
- Centre for Circulatory Health, Anglia Ruskin University, Chelmsford, Essex, UK
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Scriba MF, Kotze U, Naidoo N, Jonas E, Chinnery GE. Aorto-oesophageal fistula after corrosive ingestion: A case report. World J Gastrointest Surg 2022; 14:506-513. [PMID: 35734627 PMCID: PMC9160688 DOI: 10.4240/wjgs.v14.i5.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/23/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aorto-oesophageal fistula (AOF) are uncommon and exceedingly rare after corrosive ingestion. The authors report a case of AOF after corrosive ingestion that survived. A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition, how it is best managed and what the outcomes are.
CASE SUMMARY A previously healthy 30-year-old male, presented with a corrosive oesophageal injury after drain cleaner ingestion. He did not require acute surgical resection, but developed long-segment oesophageal stricturing, which was initially managed with cautious dilatation and later stenting. An AOF was suspected at endoscopy performed two months after the ingestion, when the patient represented with massive upper gastrointestinal bleeding. The fistula was confirmed on computerised tomographic angiography. The initial bleeding at endoscopy was temporised by oesophageal stenting; a second stent was placed when bleeding recurred later the same day. The stenting successfully achieved temporary bleeding control, but resulted in sudden respiratory distress, which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents. Definitive bleeding control was achieved by endovascular aortic stent-grafting. A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis. He was subsequently successfully discharged and remains well one year post injury.
CONCLUSION AOF after corrosive ingestion is exceedingly rare, with a very high mortality. Most occur weeks to months after the initial corrosive ingestion. Conservative management is ill-advised.
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Affiliation(s)
- Matthias Frank Scriba
- Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
| | - Urda Kotze
- Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town, Faculty of Health Sciences, Cape Town 7925, Western Cape, South Africa
| | - Nadraj Naidoo
- Vascular and Endovascular Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
| | - Eduard Jonas
- Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
| | - Galya Eileen Chinnery
- Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town 7925, Western Cape, South Africa
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24
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Zhong XQ, Li GX. Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature. World J Clin Cases 2022; 10:3814-3821. [PMID: 35647167 PMCID: PMC9100730 DOI: 10.12998/wjcc.v10.i12.3814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.
CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.
CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.
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Affiliation(s)
- Xue-Qing Zhong
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
- Medical College, Hangzhou Normal University, Hangzhou 311121, Zhejiang Province, China
| | - Guo-Xiong Li
- Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China
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25
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Chen ZC, Chen GQ, Chen XC, Zheng CY, Cao WD, Deng GH. Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta: A case report. World J Clin Cases 2022; 10:2484-2490. [PMID: 35434050 PMCID: PMC8968600 DOI: 10.12998/wjcc.v10.i8.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair (TEVAR).
CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish. No abnormal findings were observed by the emergency esophagoscopy. Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta. The patient refused to undergo surgery for personal reasons and was discharged. Five days after the onset of illness, he was readmitted to our hospital. Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus. Endoscopic ultrasonography confirmed a fishbone under the nodule. After performing TEVAR, we incised the esophageal mucosa under an endoscope and successfully removed the fishbone. The patient has remained in good condition for 1 year.
CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.
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Affiliation(s)
- Zhi-Cao Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gui-Quan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Xiao-Chun Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Chang-Ye Zheng
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Wei-Dong Cao
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gang-Hao Deng
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
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26
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Primary aortoesophageal fistula from metallic bristle ingestion. J Vasc Surg Cases Innov Tech 2022; 8:77-80. [PMID: 35128220 PMCID: PMC8799993 DOI: 10.1016/j.jvscit.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Although many patients are treated for the removal of ingested foreign objects each year, ingestions that perforate the esophagus and lead to intra-abdominal complications are rare. Aortoesophageal fistulas and aortic pseudoaneurysms are deadly complications of esophageal foreign body impaction. However, the surgical approach to aortic repair from foreign object damage has not been standardized. We have described the diagnostic, open surgical, and therapeutic approach to treating a man who had accidentally ingested a 3-cm metallic bristle that lodged in his aortic wall. The patient recovered after excision of the aortic pseudoaneurysm with CryoGraft (CryoLife, Inc, Kennesaw, Ga) replacement, drainage of abscesses, and antibiotic treatment for multiple infections.
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27
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Yi Z, Chen C, Tuo B, Li T, Liu X. An extremely dangerous case of acute massive upper gastrointestinal bleeding: a case report. BMC Gastroenterol 2022; 22:67. [PMID: 35168558 PMCID: PMC8845279 DOI: 10.1186/s12876-022-02138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Upper gastrointestinal (GI) bleeding is a severe acute disease of gastroenterology department. Fish bone is the most common food-related foreign body. However, fish bone piercing the esophagus, causing the mediastinal abscess that corroded the left subclavian artery, resulting delayed but high-risk massive upper gastrointestinal bleeding is very rare. Case presentation We report a 54-year-old man who was diagnosed with delayed but high-risk massive upper GI bleeding that was the result of a fish bone piercing the esophagus, causing a mediastinal abscess that corroded the left subclavian artery. He was saved effectively by early and timely multidisciplinary collaboration. Conclusion A fish bone-caused mediastinal abscess that corrodes the left subclavian artery and induces delayed but high-risk massive upper GI bleeding is very rare. In addition to routine consideration of upper GI bleeding, medical history, endoscopy and CT are helpful for achieving a diagnosis. Importantly, early and timely multidisciplinary collaboration can effectively save critically ill patients.
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28
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Thoracic Endovascular Aortic Repair for a Ruptured Mycotic Aortic Pseudoaneurysm Secondary to Esophageal Carcinoma. Case Rep Vasc Med 2022; 2022:5489653. [PMID: 35036021 PMCID: PMC8758314 DOI: 10.1155/2022/5489653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
A 47-year-old female presented to the emergency department with new episodes of hematemesis. She had a background of unresectable T4b + N1 + M0 esophageal squamous cell carcinoma. Contrast CT thoracic aorta diagnosed a ruptured mycotic aortic pseudoaneurysm of the descending aorta, forming a life threating aorto-esophageal fistula secondary to neoplasm. Due to the high risk of fatal haemorrhage, she underwent successful emergency thoracic endovascular aortic repair (TEVAR). Mycotic aortic pseudoaneurysms are a rare and often fatal complication of esophageal carcinomas. They represent a small subsection of aorto-esophageal fistulas. Early diagnosis with cross sectional imaging and vascular control of the sentinel bleed is essential for survival. TEVAR may be used as a bridge to palliative treatment in the case of unresectable esophageal carcinoma.
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29
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Verma M, Deshpande AA, Pandey NN, Kumar S. Periaortic air in native and post-operative aorta on computed tomography. Br J Radiol 2022; 95:20210878. [PMID: 34591649 PMCID: PMC8722262 DOI: 10.1259/bjr.20210878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Periaortic air can be seen in various conditions which can be a benign imaging finding or harbinger of a catastrophic event. The causes vary in native aorta and post-operative aorta. A radiologist has an important part in the management process of these patients, as the treatment varies from conservative to radical surgery based on the aetiology. The presence of periaortic air seen in the light of various clinical, laboratory and radiological findings can guide the radiologist towards a particular aetiology. Cross-sectional imaging, mainly computed tomography, is an indispensable tool in recognising ectopic periaortic air and to identify the associated findings and eventually make an accurate diagnosis. We present a pictorial review of various causes of the periaortic air in native and postoperative aorta, the salient features and management of the described conditions.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Ajit Deshpande
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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30
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Martino A, Oliva G, Zito FP, Silvestre M, Bennato R, Orsini L, Niola R, Romano L, Lombardi G. Acute upper gastrointestinal bleeding caused by esophageal right bronchial artery fistula: A case report. World J Gastrointest Endosc 2021; 13:565-570. [PMID: 34888008 PMCID: PMC8613674 DOI: 10.4253/wjge.v13.i11.565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery (RBA).
CASE SUMMARY An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis. Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA, in the absence of active bleeding. Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach, in the absence of active bleeding or tumor ingrowth/overgrowth. After prompt multidisciplinary evaluation, a step-up approach was planned. The bleeding was successfully controlled by esophageal restenting followed by RBA embolization. No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.
CONCLUSION This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.
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Affiliation(s)
- Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Gaspare Oliva
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Francesco Paolo Zito
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Mattia Silvestre
- Department of Interventional Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Raffaele Bennato
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luigi Orsini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Raffaella Niola
- Department of Interventional Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
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Abstract
Background Dysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica. Materials and methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades. Results A total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias. Conclusion Dysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.
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32
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Vitito L. PRIMARY AORTOESOPHAGEAL FISTULA DUE TO ESOPHAGEAL FOREIGN BODY: A CASE REPORT. Gastroenterol Nurs 2021; 44:458-462. [PMID: 34319938 PMCID: PMC8635267 DOI: 10.1097/sga.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
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33
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Ndikumana R, Lal A, Herath J. Aortoesophageal Fistula Secondary to Esophageal Diverticulum Resulting in Sudden Unexpected Death. Acad Forensic Pathol 2021. [DOI: 10.1177/19253621211038122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortoesophageal fistula (AEF) is a rarely encountered clinical outcome that is often fatal. It is most commonly a postoperative complication of vascular surgery (secondary AEF). Reported primary causes of AEF include aortic aneurysm, atherosclerosis, infection, foreign objects, achalasia with megaesophagus, gastrointestinal malignancy, and radiotherapy. Aortoesophageal fistula is often not a top diagnostic consideration for clinicians or pathologists and has the potential to be overlooked. This report describes a rare case of AEF secondary to an esophageal traction diverticulum and associated abscess that resulted in the sudden unexpected death of a 78-year-old male. Aortoesophageal fistula is an important consideration for pathologists and requires careful consideration in the postmortem setting.
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34
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Alreheili KM, Almutairi M, Alsaadi A, Ahmed G, Alhejili A, AlKhatrawi T. A 2-Year-Old Boy Who Developed an Aortoesophageal Fistula After Swallowing a Button Battery, Managed Using a Novel Procedure with Vascular Plug Device as a Bridge to Definitive Surgical Repair. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931013. [PMID: 34407064 PMCID: PMC8382025 DOI: 10.12659/ajcr.931013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Male, 2-year-old
Final Diagnosis: Aortoesophageal fistula
Symptoms: Esophageal foreign body • gastrointestinal bleeding
Medication: —
Clinical Procedure: —
Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology
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Affiliation(s)
- Khalid M Alreheili
- Department of Pediatrics, Division of Gastroenterology, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Mansour Almutairi
- Department of Pediatrics, Division of Cardiology, Madinah Cardiac Centre, Madinah, Saudi Arabia
| | - Ali Alsaadi
- Department of Radiology, Division of Gastroenterology, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Ghousia Ahmed
- Department of Pediatrics, Division of Pediatric Intensive Care, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Abdulrahman Alhejili
- Department of Pediatrics, Division of Pediatric Intensive Care, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Taha AlKhatrawi
- Department of Pediatric Surgery, Maternity and Children's Hospital, Madinah, Saudi Arabia
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35
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Camprodon G, Huguet F. Unrecognized digestive toxicities of radiation therapy. Cancer Radiother 2021; 25:723-728. [PMID: 34391649 DOI: 10.1016/j.canrad.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022]
Abstract
The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.
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Affiliation(s)
- G Camprodon
- Service d'Oncologie Médicale, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
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36
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Abstract
Background Fistulous tracts within the thorax are best exemplified aorto-esophageal fistulas (AEFs), which are rare exsanguinations of the upper gastrointestinal tract. Most of them are diagnosed at autopsy. Aim This is an autopsy-based study of fatal cases of AEFs gathered over a period of 20 years. Materials and Methods Cases of AEFs were retrieved from the autopsy records of the cardiovascular pathology sub-specialty at a tertiary care center and were studied with reference to demographic details, modes of clinical presentation, and pathological features. Results Ten cases of AEFs (10 males and 8 females, mean age of 46.9 years) were identified in a span of 20 years. A clinical diagnosis of AEF was made in only one patient, while the rest were identified at autopsy. All the patients had a bout of massive and fatal hematemesis. The fistulous connections, involving the middle-third of the esophagus, were caused by a fishbone, esophageal ulceration and aneurismal aortic diseases of varied etiology. Conclusions AEFs are often missed or misdiagnosed. Early recognition of this rapidly fatal condition is essential as these fistulas require quick and aggressive management.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology (Cardiovascular and Thoracic Division), Seth GS Medical College, Parel, Mumbai, Maharashtra, India
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37
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Al-Thani H, Wahlen BM, El-Menyar A, Hussein A, Sadek A, Fares A, Saih MM, Almulla A. Presentation, management and outcome of aorto-esophageal fistula in young patients: two case-reports and literature review. J Surg Case Rep 2021; 2021:rjab213. [PMID: 34211691 PMCID: PMC8241460 DOI: 10.1093/jscr/rjab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/14/2022] Open
Abstract
Aorto-esophageal fistula (AEF) is a rare serious surgical event. The first case developed hematemesis 2 weeks post-sleeve gastrectomy. A covered esophageal stent was placed endoscopically. The esophageal stent implantation was followed by massive bleeding due to an AEF. A thoracic endovascular aortic repair (TEVAR) was performed. Aggravated by infection of the aortic stent, another massive bleed occurred after 1 year. The final procedure was resection of the descending aorta with reconstruction using a bovine pericardial patch. The second case presented with hematemesis post-motor vehicle accident. AEF was confirmed by aortogram and treated by TEVAR followed by fully covered esophageal stent. The patient declined definite surgery. In conclusion, initial endovascular approach is useful as a bridge procedure. Once the patient hemodynamics are stabilized, a definitive surgical repair is required. The post-repair infection and life-long antibiotics could be overcome by using bovine pericardial grafts.
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Affiliation(s)
- Hassan Al-Thani
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery Section, HGH, Doha, Qatar
| | - Ahmed Hussein
- Vascular Surgery Section, Department of Surgery, HGH, Doha, Qatar
| | - Ahmed Sadek
- Vascular Surgery Section, Department of Surgery, HGH, Doha, Qatar
| | - Amr Fares
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | | | - Abdulwahid Almulla
- Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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38
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Chen KC, Wu IH, Chang CY, Huang PM, Lin MW, Lee JM. The Long-Term Clinical Impact of Thoracic Endovascular Aortic Repair (TEVAR) for Advanced Esophageal Cancer Invading Aorta. Ann Surg Oncol 2021; 28:8374-8384. [PMID: 34085143 PMCID: PMC8591004 DOI: 10.1245/s10434-021-10081-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/10/2021] [Indexed: 12/29/2022]
Abstract
Background Advanced esophageal cancer invading the aorta is considered unsuitable for surgery with definitive chemotherapy or chemoradiation as the treatments of choice. In the current study, we evaluated the long-term clinical impact of combining thoracic endovascular aortic repair (TEVAR) with multimodality treatment in caring for such patients. Methods We evaluated 48 patients who had advanced esophageal cancer with aortic invasion. The oncological outcome, including overall survival (OS) and progression-free survival (PFS), after multimodality treatment with or without TEVAR is evaluated for these patients. Results Overall, 25/48 patients (52.1%) received a TEVAR procedure. There was no significant difference in OS (p = 0.223) between patients who did or did not receive TEVAR; however, patients who received TEVAR had significantly less local tumor recurrence (p = 0.020) and longer PFS (p = 0.019). This impact was most evident in patients who received both TEVAR and esophagectomy, with an incremental increase in hazard ratio (HR) for disease progression of 2.89 (95% confidence interval [CI] 0.86–9.96) and 4.37 (95% CI 1.33–14.33) observed under multivariable analysis, respectively, in comparison with patients who underwent only one or neither of these procedures (p = 0.005 for trend test). Conclusion TEVAR is a feasible procedure for esophageal cancers invading the aorta and can be used for curative-intent resection to improve local tumor control and PFS. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10081-3.
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Affiliation(s)
- Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hui Wu
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chih-Yang Chang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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39
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Aortoesophageal fistula treated with emergent thoracic stent grafting. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:396-398. [PMID: 34278067 PMCID: PMC8261464 DOI: 10.1016/j.jvscit.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/12/2021] [Indexed: 01/06/2023]
Abstract
Aortoesophageal fistula (AEF) is a rare pathology with a poor prognosis. Historically, open repair approaches were undertaken. With the advent of endovascular techniques, alternative methods such as thoracic endovascular aortic repair (TEVAR) have emerged. This case describes a patient who presented with severe hematemesis and, upon imaging, an AEF was discovered. Urgent TEVAR was indicated with a graft oversized to the native aorta by 10% to 15%, along with coil embolization of the intercostal artery. We report here on the successful management of AEF via TEVAR.
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40
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Chen C, Kim JW, Shin JH, Kwon Y, Kim J, Lee IJ. Management of life-threatening aortoesophageal fistula: experiences learned from eight patients. Acta Radiol 2021; 62:447-452. [PMID: 32551870 DOI: 10.1177/0284185120933228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but fatal condition causing massive upper gastrointestinal bleeding. PURPOSE To report our experiences in the management of life-threatening AEF. MATERIAL AND METHODS A total of eight patients (seven men, one woman; mean age = 59.4 years; age range = 43‒76 years) presenting with AEF between 2005 and 2018 were recruited from three different Korean hospitals. The medical records of these patients were reviewed for patient demographics, clinical features, diagnostic and therapeutic modalities, and outcomes. RESULTS Two patients died as a result of massive hemorrhage before endovascular or surgical treatment could be undertaken. Of the six patients who were treated, five underwent endovascular interventions: embolization of the fistula using n-butyl cyanoacrylate (NBCA) and subsequent thoracic endovascular aortic repair (TEVAR) in two patients; TEVAR alone in two patients; and NBCA embolization alone in one patient. Among them, three patients who received TEVAR with or without NBCA embolization in a timely fashion recovered and were discharged. One patient who received delayed TEVAR died of disseminated intravascular coagulation, and one who received NBCA embolization alone died of hemorrhagic shock, both dying within three days of treatment. The remaining patient who underwent surgical aortic repair is alive after 13 years. CONCLUSION Rapid identification and surgical treatment are necessary to increase the likelihood of survival, if emergency surgery is feasible. TEVAR in a timely fashion facilitates hemodynamic stabilization by rapidly controlling hemorrhage and saves the patient's life.
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Affiliation(s)
- Chengshi Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Republic of Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
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41
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Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma. Biosci Rep 2021; 40:221747. [PMID: 31894852 PMCID: PMC6960064 DOI: 10.1042/bsr20193379] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022] Open
Abstract
The aim of the present study was to investigate the survival and prognostic factors of patients who were with advanced esophageal squamous cell carcinoma (ESCC) and developed an esophageal fistula. The data from 221 patients with advanced ESCC developed esophageal fistula from January 2008 to December 2017 at the Harbin Medical University Cancer Hospital was retrospectively analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazard models. The median survival time after a diagnosis of the esophageal fistula was calculated using the Kaplan–Meier method. We found that the pathogens infected by patients are common bacteria in nosocomial infection. Besides, the incidence rate of esophagomediastinal fistula was the highest (54.2%) in the lower third of the esophagus. Kaplan–Meier analysis revealed a median survival time of 11.00 months and a median post-fistula survival time of 3.63 months in patients who developed esophageal fistula in advanced esophageal cancer. In the univariate analysis, gender, therapies for ESCC before the development of fistula, type of esophageal fistula, treatment of esophageal fistula and hemoglobin (Hb) level were the factors with significant prognostic value. Gender, type of esophageal fistula and Hb level were identified as independent prognostic factors in further multivariate analysis. In summary, our study demonstrated that several factors are significantly related to patients with esophageal fistula and should be concerned about in clinical practice.
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42
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Glodean A, Grobholz R, El-Hag K, Ziaka M, Schmid JP. Midthoracic Pain, Sentinel Arterial Haemorrhage and Exsanguination after a Symptom-Free Interval (Chiari's Triad) is Diagnostic of Arterio-Oesophageal Fistula: A Life-Threatening Cause of Gastrointestinal Bleeding. Eur J Case Rep Intern Med 2021; 8:002134. [PMID: 33768063 DOI: 10.12890/2021_002134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Arterio-oesophageal fistulae are a very uncommon cause of severe gastrointestinal bleeding, and mostly result from an aberrant right subclavian artery and mediastinal surgery or prolonged endotracheal/nasogastric intubation. Material and Methods We present the case of a patient with an oesophageal adenocarcinoma and haematemesis due to a subclavian arterio-oesophageal fistula after mediastinal radiotherapy. Conclusion We discuss the rare, life-threatening condition of acute erosion of the left subclavian artery caused by an oesophageal tumour and presenting with Chiari's triad. LEARNING POINTS Subclavian arterio-oesophageal fistula is an uncommon, life-threatening cause of gastrointestinal bleeding.Knowledge of Chiari's triad enables early recognition of potentially fatal gastro-intestinal bleeding.A high level of suspicion is essential for prompt diagnosis and referral for surgical treatment especially in patients with malignancies of the upper gastrointestinal tract.
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Affiliation(s)
- Andra Glodean
- Department of Internal Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Rainer Grobholz
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Karim El-Hag
- Department of Internal Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Mairi Ziaka
- Department of Internal Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Jean-Paul Schmid
- Department of Internal Medicine, Clinic Barmelweid, Barmelweid, Switzerland.,Medical Faculty, University of Bern, Bern, Switzerland
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43
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Hazra D, Kota AA, Agarwal S. Salmonella Aortitis Causing Primary Aortoenteric Fistula. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02787-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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44
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Wang C, Lei L, Zhang W, Fan X. An aorto-oesophageal fistula treated with total arch repair combined with oesophageal repair. Interact Cardiovasc Thorac Surg 2021; 33:145-147. [PMID: 33585927 DOI: 10.1093/icvts/ivab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Aorto-oesophageal fistula is a rare but fatal disease. Open surgical repair or endotube repair of aorta and oesophagus save patients from circulatory deterioration, major haematemesis and severe infection. Here we present a rare case of an aorto-oesophageal fistula in the right hemi-arch caused by a fish bone treated with an alternative surgical strategy. Total aortic arch repair using the frozen elephant trunk procedure combined with oesophageal repair were performed. No aortic fistula, oesophageal fistula or artificial graft infection occurred in the follow-up.
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Affiliation(s)
- Chaojie Wang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Liming Lei
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Wenqian Zhang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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45
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Kim S, Jeon KN, Bae K. Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11020195. [PMID: 33525727 PMCID: PMC7911238 DOI: 10.3390/diagnostics11020195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell's diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.
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Affiliation(s)
- Sungbin Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Correspondence: ; Tel.: +82-55-214-3896
| | - Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
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46
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Benedetti B, Felice M, Locco F, Roberti P, Demontis R. Lethal aorto-oesophageal fistula 16 years after aortic prosthetic reconstruction: Delayed rupture as cause of death. MEDICINE, SCIENCE, AND THE LAW 2021; 61:146-149. [PMID: 32689878 DOI: 10.1177/0025802420936796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The development of aorto-oesophageal fistula (AOF) is a rare complication following thoracic aortic repair. Mortality is high, in most cases due to fatal haematemesis. The clinical onset is variable, occurring approximately one year after surgery. We report a case of a lethal AOF in a 58-year-old man. He underwent open vascular surgery 16 years prior to his death due to a rupture of the descending thoracic aorta. In the early 2000s, the open vascular approach was replaced by thoracic endovascular aortic repair. As a result of this approach, the number of surgical complications has reduced, with the exception of AOF.
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Affiliation(s)
- Beatrice Benedetti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Marica Felice
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Francesco Locco
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Paola Roberti
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
| | - Roberto Demontis
- Legal Medicine Unit, Department of Medical Sciences and Public Health,3111University of Cagliari, Italy
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47
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Manejo quirúrgico y anestésico de fístula aortoesofágica secundaria a perforación por espina de pescado: un reporte de caso y revisión de la literatura. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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48
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Vijayvergiya R, Kasinadhuni G, Sinha SK, Yadav TD, Singh H, Savlania A, Lal A, Kanabar K. Thoracic endovascular aortic repair in management of aorto-oesophageal fistulas: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33204973 PMCID: PMC7649481 DOI: 10.1093/ehjcr/ytaa295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 12/02/2022]
Abstract
Background Aorto-oesophageal fistula (AOF) is a rare, catastrophic disease with an extremely poor prognosis. A ruptured thoracic aortic aneurysm is a common aetiology for AOF. The clinical presentation is usually massive haematemesis and collapse. Timely diagnosis and appropriate treatment are crucial in managing AOF. Case summary We hereby report two cases of AOF, who underwent successful emergency thoracic endovascular aortic repair (TEVAR) to control active bleed and exsanguination. Case 1, an elderly lady with atherosclerotic aneurysm had TEVAR followed by open surgery for oesophageal rent and necrosed left main bronchus. Case 2 had mycotic tubercular aneurysm who later had infected graft-stent following TEVAR. Discussion Open surgery is the conventional treatment for AOF; however, TEVAR can be an alternative and less invasive approach in selected high-risk patients. Various management issues related to TEVAR with AOF have been discussed in the article.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Thakur Deen Yadav
- Department of Gastro-intestinal Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Harkant Singh
- Department of Cardio-thoracic Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Ajay Savlania
- Department of Vascular Surgery, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Anupam Lal
- Department of Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
| | - Kewal Kanabar
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India
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49
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Popova IE, Danielian SN, Pogodina AN, Chernaia NR, Muslimov RS, Mironov AV, Kokov LS. [Peculiarities of diagnosis and emergency surgical care in aorto-oesophageal fistula]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:108-114. [PMID: 33063757 DOI: 10.33529/angiq2020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An aorto-oesophageal fistula is a rare but life-threatening pathological condition developing on the background of diseases of the aorta and oesophagus, as well as after surgical interventions on the aorta. The article deals with a clinical case report regarding management of a patient presenting with an aorto-oesophageal fistula resulting from a thoracic artery aneurysm. The main clinical manifestations of the diseases included dysphagia (due to oesophageal obstruction caused by thrombotic masses of the aneurysm) and the occurring gastrointestinal haemorrhage. Comprehensive instrumental diagnosis was performed using roentgen examination of the oesophagus, oesophagoscopy, and contrast-enhanced computed tomography of the chest. The obtained findings made it possible to objectively assess the patient's state, to carry out timely treatment in conditions of a surgical hospital, and to avoid severe complications.
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Affiliation(s)
- I E Popova
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - Sh N Danielian
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A N Pogodina
- Department of Thoracoabdominal Surgery, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - N R Chernaia
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - R Sh Muslimov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - A V Mironov
- Department of Emergency Surgery, Endoscopy and Intensive Therapy, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia
| | - L S Kokov
- Department of Radiodiagnosis, Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department, Moscow, Russia; Department of Radiodiagnosis of the Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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50
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Yang KC, Lin MY, Huang LT, Chang WL. Massive upper gastrointestinal bleeding caused by an intercostal arterio-esophageal fistula: A rare case report. Radiol Case Rep 2020; 15:2026-2030. [PMID: 32922582 PMCID: PMC7475065 DOI: 10.1016/j.radcr.2020.07.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023] Open
Abstract
Arterio-esophageal fistula (AEF) is a rare life-threatening cause of upper gastrointestinal bleeding. Realizing the risk factors and clinical presentations of AEF will enable us to provide timely diagnosis, efficient treatment, and better outcome. We present a 43-year-old Taiwanese man who had histories of destructive lung, innominate artery-trachea fistula, and received bilobectomy. He was admitted to our hospital with fresh blood drainage from nasogastric tube. He was diagnosed as right fifth intercostal artery esophageal fistula by computed tomography angiography and transcatheter arterial embolization was performed. The bleeding stopped and the patient was discharged uneventfully. The risk factors of AEF include esophageal foreign body, vascular surgery, thoracic arterial malformations, and concurrent chemoradiotherapy in T4-esophageal cancer. Computed tomography angiography may be the most sensitive diagnostic test. Transcatheter arterial embolization or endovascular stent grafting may be considered as the first-line treatment of AEF in the future.
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Affiliation(s)
- Kai-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, Taiwan
| | - Men-Ying Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, Taiwan
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