A combined minimally invasive approach for the treatment of aortoesophageal fistula caused by the ingestion of a chicken bone: case report and literature review

Chen, Xiao; Li, Jianwen; Chen, Jie; Zhou, Yu; Zhang, Yuanqi; Ding, Hongfei; Huang, Shuichuan; Zhang, Zhi

doi:10.6061/clinics/2012(02)19

Cited by 20 publications

(8 citation statements)

References 10 publications

(14 reference statements)

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“…Meanwhile, esophageal stent placement carries the risks of severe adverse events, including stent migration that requires repositioning or replacement [ 4 ]. More importantly, the main purpose of esophageal stent placement in AEF patients involves the prevention of aortic graft contamination as a bridging therapy in the urgent phase [ 10 – 12 ]. In our case, his infection and bleeding were controlled, and his main demand was to return to a normal oral diet.…”

Section: Discussionmentioning

confidence: 99%

Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment

Zhang

Yuan

et al. 2021

BMC Gastroenterol

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Background Aorto-esophageal fistula (AEF) caused by foreign bodies ingestion is a rare but devastating disorder. Thoracic endovascular aortic repair (TEVAR) has become a widely accepted intervention for treating aorto-esophageal fistulas. As for post-TEVAR esophageal defect, secondary esophagectomy has been the recommended choice for most of the AEFs, but there is no general consensus with regard to the need of secondary surgeries for patients in the absence of clear signs of reinfection or bleeding. We herein presented a case of an AEF caused by fishbone ingestion, after successful TEVAR, the esophageal lesion was closed endoscopically. Case presentation A 38-year-old male presented with esophageal fistula for 4 months. He was diagnosed with AEF because of Chiari's triad after fishbone ingestion 4 months ago. Emergency thoracic aortic stent implantation was done, and given broad spectrum antibiotics and blood transfusion. His symptoms were improved, and discharged with an esophageal fistula left to heal itself. Nevertheless, after 4 months, re-examination of esophago-gastro-duodenoscopy revealed that the diameter of the fistula was changed from 3 to 6 mm. He was then admitted to our hospital for esophageal fistula repair. Laboratory examinations and chest computed tomography showed no signs of active infection, and endoscopic closure of the fistula was achieved with 4 clips. After that, he was discharged and gradually returned to normal diet. Conclusion For AEFs in the absence of active infection with repaired aorta but persistent esophageal fistula, endoscopic closure by endoclips might be an effective treatment choice.

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Section: Discussionmentioning

confidence: 99%

Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment

Zhang

Yuan

et al. 2021

BMC Gastroenterol

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“…Once AEF is diagnosed, emergent surgery is needed [1,4]. There is currently no unified ideal treatment for AEF caused by an esophageal foreign body.…”

Section: Discussionmentioning

confidence: 99%

“…Whether thoracic endovascular aortic repair (TEVAR) can be used as a definitive treatment for AEFs is very controversial [ 1 , 5 ]. Many successful TEVAR cases have required additional thoracic surgeries, such as thoracoscopic or open surgery for mediastinal debridement and drainage, and esophageal repair [ 4 , 6 ]. Most of the available evidence has shown that TEVAR is the first choice for rescuing patients with unstable hemodynamic parameters [ 1 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Aortic penetration due to a fish bone: a case report

Jiang

Lü

Zhang

et al. 2020

J Cardiothorac Surg

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Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

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“…[17,18,20] However, now it is recommended that combined surgical, minimally invasive procedures such as endovascular and oesophageal stent replacement will yield better results with minimal morbidity and mortality. [21,22,23] In this patient the history was not followed by the essential investigations such as chest X-ray or upper GI endoscopy and the surgical team did not suspect or attempt to treat aorto-oesophageal fistula until massive bleeding took place. Therefore, we would also like to highlight the medico legal aspects of this case.…”

Section: Discussionmentioning

confidence: 99%

Aorto-oesophageal fistula secondary to impaction of a fish bone at autopsy

et al. 2016

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Aorto-oesophageal fistula is a life threatening condition in which there is an abnormal connection between the aorta and oesophagus, and is a rare complication of foreign body ingestion from which few patients survive. Classic presentation is with Chiari's triad of mid thoracic pain, sentinel arterial haemorrhage and massive exsanguination after a symptom free interval. A 36-year-old male was transferred to a tertiary care hospital with a history of epigastric pain and discomfort in his retro-sternal area. According to the history, he had ingested fish the previous day while consuming alcohol. He was treated for four days in the hospital, and discharged with a diagnosis of alcohol induced gastritis. He was re-admitted later the same day with an episode of haematemesis. However, investigations such as chest radiography and oesophagogastroduodenoscopy were not carried out. He developed massive haematemesis 12 hours later, and despite vigorous resuscitation and emergency surgery, he expired. Autopsy revealed an impacted fish bone at the junction of upper and middle third of the oesophagus creating a fistula tract from oesophagus to thoracic aorta which resulted in exsanguination, haemorrhagic shock and death. Even though mortality is very high, survival is possible with a high index of suspicion, early diagnosis and rapid surgical intervention. Autopsy findings, review of the literature and medico-legal aspects of possible medical negligence are discussed.

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A combined minimally invasive approach for the treatment of aortoesophageal fistula caused by the ingestion of a chicken bone: case report and literature review

Cited by 20 publications

References 10 publications

Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment

Aorto-esophageal fistula caused by fishbone ingestion: a case report on staged endovascular and endoscopic treatment

Aortic penetration due to a fish bone: a case report

Aorto-oesophageal fistula secondary to impaction of a fish bone at autopsy

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