A Case of Aortoesophageal Fistula in Advanced Esophageal Cancer Treated with SB-Tube and TEVAR / 日本心臓血管外科学会雑誌

The patient is a 71-year-old man. After receiving chemoradiotherapy (CRTx) for an unresectable esophageal cancer, he developed sudden hematemesis during a follow-up examination. Subsequent imaging via contrast-enhanced computed tomography (CT) showed leakage of the contrast medium from the descending aorta into the esophagus. Consequently, an aortoesophageal fistula (AEF) was diagnosed and an emergency thoracic endovascular aortic stent graft repair (TEVAR) was scheduled. However, during the preparation for surgery, the patient vomited a large amount of blood and went into cardiopulmonary arrest. Following the administration of cardiopulmonary resuscitation, a Sengstaken-Blakemore tube (SB-tube) was inserted intranasally to control bleeding and TEVAR was performed to save his life. Although a gastrostomy was necessary after the surgery, the patient was transferred from the hospital on the 32nd day without any complications. Nonetheless, his general condition deteriorated as the cancer progressed and he died on the 103rd postoperative day. It is generally reported that the risk for esophageal perforation is 10-20% in CRTx for unresectable esophageal cancer. Although issues regarding the long-term prognosis of patients treated with TEVAR have been highlighted in recent years, there have also been reports of life-saving cases following its use; in this case, the patient was discharged home after SB-tube insertion and TEVAR with prompt treatment, resulting in his life being prolonged for an estimated 3 months.

Hemorrhagic shock caused by double aortic arch and aortoesophageal fistula in a newborn: a case report and literature review / 中国新生儿科杂志

Objective:To study the clinical characteristics of double aortic arch (DAA) combined with aortoesophageal fistula (AEF), and summarize the diagnosis and treatment experience.Methods:Retrospective analysis was performed on the diagnosis and treatment of a newborn with hemorrhagic shock caused by DAA combined with AEF in the Guangzhou Women and Children's Medical Center. The key searching words included "double aortic arch", "aortoesophageal fistula", "vascular ring", "newborn or neonate", and "infant, newborn". The relevant reports were retrieved from databases of CNKI, Wanfang, VIP, PubMed, Springer Link, Google Scholar, Web of Science, Embase, Cochrane Library and OVID, to summarize the clinical features, diagnosis and treatment experience of neonates with DAA and AEF. The retrieval deadline was December 31, 2020.Results:A full-term female newborn was hospitalized for dyspnea immediately after birth, and failed to evacuate from the ventilator for several times. The patient was fed with nasogastric tube and transferred to our hospital because of hemorrhagic shock occurring in 32 days after birth, and gastrointestinal bleeding occurred repeatedly with the maximum bleeding volume reaching 200 ml/time. DAA was diagnosed by cardiac ultrasound and CT, AEF hemorrhage was finally confirmed by gastroscopy, aortography and operation. DAA correction and esophagus repair were successfully performed, and the infant recovered well after the operation. At 9-month old, the infant grew and developed well. At present, no reports of DAA combined with AEF neonates have yet to be published in medical literatures in China. Seven English language literatures included 7 cases of AEF complicated with DAA in neonatal period, 5 cases survived and 2 cases died have so far been reported. All patients have a long history of gastric tube indwelling.Conclusions:The incidence of DAA combined with AEF is rare in the newborn with respiratory and swallowing difficulties as the first manifestation. The disease symptoms progressed rapidly, and life-threatening digestive tract hemorrhage may occur, which often requires surgical treatment. Prolonged gastric tube retention should be avoided in DAA children to prevent the occurrence of AEF.

Endoscopic Diagnosis of Aortoesophageal Fistula Not Presenting Hematemesis / 대한소화기학회지

Aortoesophageal fistula (AEF) is an extremely rare but lethal cause of massive gastrointestinal hemorrhage. Characteristic symptoms are mid-thoracic pain, sentinel minor hemorrhage, and massive hemorrhage after a symptom-free interval. Prompt diagnosis and immediate treatments are necessary to reduce mortality. However, AEF is difficult to diagnose because it is uncommon and often leads to death with massive bleeding before proper evaluation. We report a case of endoscopic diagnosis of AEF that did not present with hematemesis; it was treated with thoracic endovascular aortic repair (TEVAR) and surgery. A 71-year-old female presented to the emergency department with epigastric discomfort. Endoscopy demonstrated a submucosal tumor-like protrusion and pulsating mass with blood clots. Contrast-enhanced chest CT confirmed AEF due to descending thoracic aortic aneurysm. The patient immediately underwent TEVAR to prevent massive bleeding and subsequently underwent surgery. Endoscopists should consider AEF if they see a submucosal tumor-like mass with a central ulcerative lesion or a pulsating protrusion covered with blood clots in mid-esophagus during an endoscopy.

Open Repair without Esophagectomy for an Aortoesophageal Fistula after Thoracic Stent Grafting / 日本心臓血管外科学会雑誌

An aortoesophageal fistula is a critical condition with high operative mortality. A case of aortoesophageal fistula following thoracic endovascular aneurysm repair is reported. The patient was a 72-year-old man complaining of dysphagia who underwent stent grafting for a saccular aneurysm of the descending aorta that was compressing the esophagus four months earlier. Endoscopic examination showed perforation of the aneurysm into the esophagus with severe stenosis. The aneurysmal sac was filled with thrombus. Aortography demonstrated a type I endoleak from the lesser curvature of the aortic arch, draining into the aneurysmal sac. The patient was afebrile with moderate elevation of C-reactive protein, and the white blood cell count was normal. The patient underwent closure of the aneurysmal entry with healthy aortic wall and replacement of the descending aortic aneurysm with a prosthetic graft. The graft was isolated from the fistula by an omental flap. The patient's postoperative course was uneventful. Computed tomography performed 4 years after the surgery showed shrinkage of the aneurysmal sac. The patient has had a healthy life for 9 years since the operation.

A Case of Endovascular Stent Grafting for an Aortoesophageal Fistula / 대한내과학회지

An aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding. The standard treatment of an aortoesophageal fistula is surgical, because conservative management results in very high mortality. Nevertheless, the mortality related to the surgical treatment ranges from 30 to 60%. Recently, endovascular stent grafting has become an alternative to open surgery in selected patients. We report an aortoesophageal fistula treated with endovascular stent grafting in an 84-year-old female with hematemesis and abdominal pain. Endoscopy showed a 5-cm pulsating esophageal mass with central ulceration and bleeding. Computed tomography (CT) of the abdomen revealed a descending thoracic aortic pseudoaneurysm. Being at high risk in open thoracic surgery, she underwent endovascular stenting. We suggest that endovascular stent grafting is an alternative treatment of aortoesophageal fistula, instead of open surgery, in selected patients.

A Case of Aortoesophageal Fistula Complicated by a Stent for Benign Esophageal Stricture / 대한소화기내시경학회지

Self-expandable metallic stents (SEMS) are widely used for the palliative treatment of malignant strictures of the gastrointestinal tract. Recently, several studies tested whether a SEMS is an effective and safe option for benign esophageal stricture. Serious complications such as hemorrhage, compression of the bronchus, bronchoesophageal fistula, and esophageal rupture were infrequently encountered as complications of esophageal stent placement. Aortoesophageal fistula is extremely rare as a complication of esophageal SEMS insertion; only seven cases have been reported worldwide. We now report a case of an 80-year old female with aortoesophageal fistula after placement of a SEMS for an esophageal stricture.

A case of an aortoesophageal fistula presenting as a Dieulafoy-like lesion / 대한내과학회지

A 68-year-old woman visited our emergency center because of hematemesis. An emergency endoscopy showed an exposed vessel with blood flowing into the upper esophagus. Angiography revealed the presence of extravasation of contrast at the level of the aortic arch and a tortuous fistula between the aortic arch and esophagus. Chest computerized tomography demonstrated the presence of an aortoesophageal fistula and air bubbles inside the fistula. The patient had emergency surgery and the intraoperative findings revealed an aortoesophageal fistula and necrotic materials with a foul odor at the upper esophagus. Primary closure and wrapping of the aorta were performed, but primary closure of the esophagus was impossible because of necrosis. An aortoesophageal fistula is a rare but life-threatening disease. As shown for this patient, an exposed vessel without ulceration at the upper esophagus should raise suspicion of an aortoesophageal fistula and a CT scan or angiography should be performed before endoscopic intervention.

Fístula aortoesofágica: hemorragia digestiva alta exanguinante: a propósito de un caso / A case of massive upper gastrointestinal hemorrage as a consequence of an a orto-esophageal fistula

Presentamos el caso de un varón de 70 años que sufrió una hemorragia digestiva alta exanguinante, con resultado final de muerte. Fue diagnosticada una fístula aorto-esofágica mediante escáner como causante de la misma, debida con alta probabilidad a una espina de pescado.

We report a case of a 70 old man, who suffered a severe upper gastrointestinal haemorrhage, with final result of death. A scanner diagnosed an aortoesophageal fistula, due with high probability to a fish thorn.

Aortoesophageal Fistula and Sudden Death: A Report of a Case and Review of the Literature / 대한법의학회지

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. Sign and symptoms of gastrointestinal hemorrhage followed by sudden collapse hours to days later prompt consideration of an aortoesophageal fistula. So sudden and unexpected deaths occur in usually hospitalized patient with a diagnosis of potentially lethal disease has never been made. And most death cases of aortoesophageal fistula have an actual or potential medicolegal aspect. We report a case of aortoesophageal fistula with the discussion of the etiology, symptoms and diagnosis of aortoesophageal fistula.

Aorto-Esophageal Fistula Complicated by Esophageal Metalic Stent: A case report / 대한흉부외과학회지

Aortoesophageal fistula induced by endoesophageal stent is rare;however,it is usually a fatal disorder,with few survivors reported.We report a case of a 32-year old female with aortoesophaeal fistula after insertion of the esophageal stent in esophageal lye stricture who was successfully diagnosed with endoscopy and treated in a two-stage operation.In the first stage,we performed esophagectomy,primary repair of the fistula site in the descending thoracic aorta,and feeding gastrostomy.After the patient recovered well postoperatively,a retrosternal interposition of the right colon and cervical esophago-colo-grastostomy were performed,to re-establish the gastrointestinal tract.