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Hirai T, Okajima M, Noda T, Goto Y. Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta. Int J Emerg Med 2024; 17:117. [PMID: 39243008 PMCID: PMC11380427 DOI: 10.1186/s12245-024-00706-1] [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: 02/26/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal hemorrhage. Despite diagnostic and therapeutic advances, the mortality rate in AEF patients remains high because of its fulminant course, even with maximal intensive care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a resuscitation technique to control life-threatening bleeding. It has become an important modality in the management of life-threatening, traumatic or non-traumatic, arterial bleeding. However, it's use in hemorrhagic shock caused by cancer has rarely been reported. CASE PRESENTATION A 51-year-old woman with a history of esophageal cancer presented to our emergency department with hematemesis. Computed tomography was performed because of a strong suspicion of hemorrhagic shock. With a diagnosis of AEF due to esophageal cancer, emergency thoracic endovascular aortic repair was performed while the bleeding was controlled using REBOA. Staged elective esophageal reconstruction was successfully performed. CONCLUSIONS Hemostasis is crucial in patients who present with suspected hemorrhagic shock attributable to AEF. The timely implementation of REBOA has shown promise and potential effectiveness in such cases.
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Affiliation(s)
- Tadayuki Hirai
- Department of Emergency, Kanazawa University Hospital, 13 -1, Takaramachi, Kanazawa City, Ishikawa Prefecture, 920-8641, Japan.
| | - Masaki Okajima
- Department of Emergency, Kanazawa University Hospital, 13 -1, Takaramachi, Kanazawa City, Ishikawa Prefecture, 920-8641, Japan
| | - Toru Noda
- Department of Emergency, Kanazawa University Hospital, 13 -1, Takaramachi, Kanazawa City, Ishikawa Prefecture, 920-8641, Japan
| | - Yoshikazu Goto
- Department of Emergency, Kanazawa University Hospital, 13 -1, Takaramachi, Kanazawa City, Ishikawa Prefecture, 920-8641, Japan
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Ristovska EC, Krstevski G, Andov M, Kolev A, Bundovski K, Rusiti K, Antovic S, Rankovic I, Kocev SB, Alcinova NH, Bogut A. Upper gastrointestinal bleeding from primary aortoesophageal fistula in a patient with aneurism of the thoracoabdominal aorta: Case report and literature review. Clin Case Rep 2024; 12:e9311. [PMID: 39156197 PMCID: PMC11327272 DOI: 10.1002/ccr3.9311] [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: 12/27/2023] [Revised: 06/09/2024] [Accepted: 07/10/2024] [Indexed: 08/20/2024] Open
Abstract
Key Clinical Message Upper gastrointestinal bleeding due to primary aortoesophageal fistula is a rare clinical condition burdened with high mortality rate. However, the outcomes are closely related to the level of clinical awareness, the complementary and multidisciplinary approach during the diagnostic workup, and the selected treatment option. Abstract We present an atypical case of an aneurysm of the thoracoabdominal aorta complicated with primary aortoesophageal fistula (AEF). A 55-year-old male with no previous diseases, presented with prolonged and intense back pain and upper gastrointestinal bleeding. The gastroscopy detected an unusual culprit lesion in the distal esophagus resembling an esophageal wall defect, and the computed tomography revealed an aneurysm of the thoracoabdominal aorta, remarkable surrounding hematoma, and active contrast extravasation. Despite the urgent surgical repair, a lethal outcome occurred. AEF patients require high clinical awareness and complementary multidisciplinary approach in order to provide a rapid diagnosis and optimal treatment.
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Affiliation(s)
- Elena Curakova Ristovska
- University Clinic for GastroenterohepathologySkopjeRepublic of North Macedonia
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
| | - Gregor Krstevski
- University Clinic for GastroenterohepathologySkopjeRepublic of North Macedonia
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
| | - Misel Andov
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
- University Clinic of Thoracic and Vascular SurgerySkopjeRepublic of North Macedonia
| | - Aleksandar Kolev
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
- University Clinic for State Cardiac SurgerySkopjeRepublic of North Macedonia
| | - Kristijan Bundovski
- University Clinic for State Cardiac SurgerySkopjeRepublic of North Macedonia
| | - Kemal Rusiti
- University Clinic of Digestive surgerySkopjeRepublic of North Macedonia
| | - Svetozar Antovic
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
- University Clinic of Digestive surgerySkopjeRepublic of North Macedonia
| | - Ivan Rankovic
- Department of Gastroenterology and Liver UnitRoyal Cornwall Hospitals NHS trustTruroEnglandUK
- University School of Medicine PeninsulaNHS EducationLondonEngland SouthwestUK
| | - Smiljana Bundovska Kocev
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
- University Clinic of RadiologySkopjeRepublic of North Macedonia
| | | | - Ante Bogut
- School of Medicine, University of MostarMostarBosnia and Herzegovina
- Department of GastroenterologyUniversity Hospital MostarMostarBosnia and Herzegovina
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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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Lee YP, Ozaki K, Oshima S, Hirokami T. Aortoesophageal fistula treated using one-stage total reconstruction: a case report from a high-volume center. J Cardiothorac Surg 2023; 18:329. [PMID: 37964318 PMCID: PMC10647152 DOI: 10.1186/s13019-023-02438-4] [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: 03/13/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction. CASE PRESENTATION This case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results. CONCLUSIONS For postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.
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Affiliation(s)
- Yi-Ping Lee
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
- Division of Thoracic and Cardiovascular Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| | - Kensuke Ozaki
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, 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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