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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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Owczarek AD, Viniol S, König AM, Görlach J, Denzer UW, Stathopoulos P, Mahnken AH. pTEVAR of an aorto-esophageal fistula in esophageal cancer: Case report and review of the literature. Radiol Case Rep 2023; 18:2526-2530. [PMID: 37235084 PMCID: PMC10208794 DOI: 10.1016/j.radcr.2023.04.037] [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: 03/09/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
An aorto-esophageal fistula (AEF) is a rare and life-threatening situation, associated with aneurysms, foreign bodies, infiltrating tumors, and radiotherapy. The ideal management is unclear. Open surgery of AEF has a high mortality and morbidity. Thoracic endovascular aortic repair (TEVAR) of an AEF is an effective and safe emergency treatment for these patients. We describe a case of AEF due to esophageal cancer successfully treated the first time by total percutaneous TEVAR (pTEVAR). A 70-year-old male patient presented with massive hematemesis at the emergency department. The patient had a known history of esophageal cancer previously treated by radiochemotherapy which was completed 3 days before. Emergency upper gastrointestinal endoscopy failed to stop the bleeding. Subsequent contrast-enhanced computed tomography revealed an aorto-esophageal fistula and emergency pTEVAR was performed. The bleeding stopped directly after stent graft placement and the patient was discharged after 10 days later. He died 3 months after pTEVAR from cancer progression. pTEVAR is an effective and safe treatment option for AEF. It can be applied as a first-line treatment and offers the potential to improve survival in the emergency setting.
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Affiliation(s)
- Andreas D. Owczarek
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Alexander M. König
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Jannis Görlach
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
| | - Ulrike W. Denzer
- Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Petros Stathopoulos
- Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps University of Marburg, Marburg, Germany
| | - Andreas H. Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University of Marburg, Baldingerstrasse, D-35043, Marburg, Germany
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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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Omran S, Ardalani L, Beyer K, De Bucourt M, Gombert A, Buerger M, Frese JPB, Greiner A. Management of Tumor- and Nontumor-related Aorto-esophageal and Aorto-bronchial Fistulas. Ann Vasc Surg 2020; 72:419-429. [PMID: 33227472 DOI: 10.1016/j.avsg.2020.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aims to review and compare the clinical presentation, management, and outcome in patients with tumor-related (TR) and nontumor-related (NTR) aorto-esophageal fistula (AEF) and aorto-bronchial fistula (ABF) with particular focus on the thoracic endovascular aortic repair. METHODS We retrospectively reviewed a series of 16 consecutive patients with TR (n = 8) and NTR (n = 8), ABF (n = 6), and AEF (n = 10) admitted to our hospital from 2011 to 2019. RESULTS The median age was 62 years (range 46-81), with 11 men. The most common predisposing factor was esophageal or gastric cardia cancer (n = 6), followed by open repair of the thoracic aorta (n = 5). Endoluminal vacuum therapy (Endo-SPONGE®) accounted for 3 cases of AEFs. Thoracic endovascular aortic repair (TEVAR) was applied in 13 patients (4 with ABFs and 9 with AEFs). The primary technical success of the TEVARs was 100%. One patient (8%) was complicated with postoperative middle cerebral artery syndrome and left-sided hemiparesis. The respective in-hospital, 6-month, and 1-year mortality rates were 0% (n = 0), 25% (n = 2), and 25% (n = 2) for the NTR group and 63% (n = 5), 88% (n = 7), and 100% (n = 8) for the TR group. After a mean period of 13 months, 5 (31%) patients were still alive, and one patient lost to follow-up after 11 months. The survivors (n = 5) had all nontumor-related ABF. Progression of underlying cancer and hemodynamic shock were the most common causes of death. CONCLUSIONS TEVAR represents a reliable option in the treatment of NTR ABFs. In the cases of TR fistulas and NTR AEFs, TEVAR should be applied more selectively. The associated mortality remains very high.
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Affiliation(s)
- Safwan Omran
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany.
| | - Lavinia Ardalani
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Charité - Universitätsmedizin Berlin, Surgical Clinic, Campus Benjamin Franklin, Berlin, Germany
| | - Maximilian De Bucourt
- Charité - Universitätsmedizin Berlin, Department of Radiology, Campus Benjamin Franklin, Berlin, Germany
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Buerger
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Jan Paul Bernhard Frese
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, Clinic of Vascular Surgery, Campus Benjamin Franklin, Berlin, Germany
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Guerrero I, Cuenca JA, Cardenas YR, Nates JL. Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer. Cureus 2020; 12:e7146. [PMID: 32257691 PMCID: PMC7105269 DOI: 10.7759/cureus.7146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished.
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Affiliation(s)
- Ivan Guerrero
- Department of Surgery, San Ignacio Hospital-Pontificia Universidad Javeriana, Bogota, COL
| | - John A Cuenca
- Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yenny R Cardenas
- Department of Critical and Intensive Care, Hospital Universitario Fundación Santa Fe De Bogotá, Bogota, COL
| | - Joseph L Nates
- Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, USA
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Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study. Esophagus 2020; 17:74-80. [PMID: 31587121 DOI: 10.1007/s10388-019-00696-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Locally advanced esophageal cancer occasionally invades the aorta, and hemorrhage from the esophagoaortic fistula can cause sudden death. Thoracic endovascular aortic repair (TEVAR) enables hemostasis in such cases, and prophylactic TEVAR can prevent fatal hemorrhagic events during treatment. However, its efficacy in Japan has not been evaluated. This study aimed to clarify the clinical significance of TEVAR in esophageal cancer patients. METHODS The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized member institutes of the Authorized Institutes for Board Certified Esophageal Surgeons. Patients who underwent TEVAR for esophageal cancer were identified from 19 institutes. Data on patient demographics, treatment performed, and survival rate were obtained using the questionnaire. The Kaplan-Meier method was used for survival analysis and to compare differences in survival rates between those who underwent TEVAR for hemorrhage and those for preoperative prophylaxis. RESULTS Of the 41 patients identified, 20 patients underwent TEVAR for hemorrhage or impending hemorrhage from the esophagoaortic fistula, while 21 patients underwent TEVAR as preoperative prophylaxis. The median survival time after TEVAR was 135 days in the hemorrhage or impending hemorrhage group and 378 days in the preoperative prophylaxis group. Eighteen patients underwent esophagectomy after TEVAR. No hemorrhagic event was observed during the perioperative period. The median survival time of the patients who underwent esophagectomy was 373 days. Some patients who achieved R0 resection obtained long-term survival. CONCLUSION TEVAR is an efficacious modality to control a life-threatening hemorrhage from esophagoaortic fistula and helps to prolong the survival of patients with locally advanced esophageal cancer invading the aorta.
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Zhan Y, Xu Z. Massive hemorrhage from an aortoesophageal fistula caused by esophageal stent implantation: A case report and literature review. Medicine (Baltimore) 2019; 98:e18303. [PMID: 31860979 PMCID: PMC6940160 DOI: 10.1097/md.0000000000018303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.
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Lee JH, Kim E, Choi YH. Encephalitis as a complication of a spinal-esophageal fistula due to discitis. Clin Case Rep 2019; 7:2190-2193. [PMID: 31788277 PMCID: PMC6878085 DOI: 10.1002/ccr3.2471] [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: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022] Open
Abstract
In patients with back or scapular pain, if there is evidence of neurological symptoms, fever, chills, malaise, or other signs of infection, the work-up should consider the possibility of a spinal-esophageal fistula.
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Affiliation(s)
- Jae Hee Lee
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
| | - Eun Kim
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
| | - Yoon Hee Choi
- Department of Emergency MedicineCollege of MedicineEwha Womans UniversitySeoulKorea
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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