Aortoesophageal fistula caused by aneurysm of the thoracic aorta: Successful surgical treatment, case report, and literature review

Abstract

Aortoesophageal fistula induced by atherosclerotic thoracic aortic aneurysm is rare, but is usually a fatal disorder, with few survivors reported. We report the case of a 72-year-old man with aortoesophageal fistula successfully treated in a two-stage operation. In the first stage, we performed resection and replacement of the aortic aneurysm with a prosthetic graft in situ, esophagectomy, cervical esophagostomy, and jejunostomy. After the patient recovered well postoperatively, a transmediastinal retrosternal interposition of the stomach was performed, with esophagogastroanastomosis in the cervical area, to re-establish the gastrointestinal tract. We include a discussion of the causes, diagnostic approach, management of the aorta and esophagus, and review of the literature.

Emergency repair of a radiation-induced aortoesophageal fistula with endograft: Report of a case

“…21,24,25 The majority of lesions are located between 20 and 30 cm from the superior dental arch. 2 The lesion was identifi ed at 25 cm in the current patient. This is the level at which the esophagus and aorta are in the closest proximity.…”

“…1,2 Several secondary causes such as esophageal perforation have been identifi ed, 3 but very few cases of radiation-induced AEF have been reported. Aortoesophageal fi stulas are often diagnosed posthumously due to their rapidly catastrophic course.…”

Aneurisma de aorta com ruptura para esôfago

“…Almost a century later, in 1914, Chiari described the classic triad of thoracic pain, sentinel hemorrhage and fatal hemorrhage 3 . The causes of AEF described to date are aneurysms and perforating ulcers of the thoracic aorta, esophageal perforation by foreign body, esophageal surgery, mediastinitis due to tuberculosis, radiotherapy and stent implant in the thoracic aorta 2,4 . The prognosis is poor and the evolution e61…”

“…The recommended conducts are not uniform and the experience in the treatment of the AEF is not consistent. For the aortic correction, the most often used technique is the in situ repair, with the extra-anatomic repair being an uncommon alternative 2 . Although the left atrial-to-femoral or femoro-femoral circulatory support is frequently used associated to the CSF drainage, the urgency of the situation many times does not allow such measures to be taken and the ischemic clamping is chosen 7 .…”

“…However, the conservative approach inevitably leads to the patient's death 1 . Its treatment aims at the control of the hemorrhage, the sepsis management and the food tract reconstruction 2 . The main causes of aortoesophageal fistulas are the thoracic aorta aneurysms, responsible for 2/3 of the cases, the ingestion of foreign bodies, tumors and esophageal surgeries, as well as surgical interventions in the thoracic aorta 1,2 .…”