Management options for aorto-oesophageal fistula: case histories and review of the literature

Göbölös, László; Pousios, Dimitrios; Tsang, GM; Livesey, Steven; Cw, Barlow; Kaarne, Markku; Shambrook, James; Lipnevičius, Artūras; Ohri, S K

doi:10.1177/0267659113476329

Cited by 17 publications

(15 citation statements)

References 10 publications

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“…3) 1, 2. Although there is no specific guidance on the use of endovascular intervention for aorto‐esophageal fistula, the European Society of Cardiology (ESC) recommends TEVAR for complex type B dissection and comparable conditions 3.…”

Section: Discussionmentioning

confidence: 99%

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

Wormald

Dindyal

Thomas

et al. 2016

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

Wormald

Dindyal

Thomas

et al. 2016

Clinical Case Reports

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“…[ 8 ] Other causes described in the literature are cancer, acid reflux disease, trauma, caustic ingestion, and esophageal biopsies. [ 3 8 ] AEFs are classified as primary if they are caused by the spontaneous erosion of the aortic wall into the esophagus and as secondary if they occur as a complication following aortic or esophageal surgeries. Owing to the increasing number of interventions of the aorta, secondary AEF is 10 times more common than primary.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracic aneurysm is the most common cause of this condition. [ 3 ] As the thoracic aneurysm grows in size, the increasing tension on its wall will erode the aorta and rupture into the surrounding esophagus leading to uncontrolled bleeding. [ 4 ] As ulcer related or variceal bleeding constitutes for most of the UGIB bleeding, even in elderly who are at risk of AEF and the inability of the esophagogastroduodenoscopy (EGD) to detect most cases, AEF is often not diagnosed timely.…”

Section: Introductionmentioning

confidence: 99%

Primary aorto-esophageal fistula: Great masquerader of esophageal variceal bleeding

Kokatnur

Rudrappa

2015

Indian Journal of Critical Care Medicine

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Aorto-esophageal fistula is a rare cause of upper gastrointestinal bleeding. Thoracic aneurysm, the most common cause of this condition, will slowly increase over time and can erode the wall of the aorta creating a fistula and leading to torrential bleeding. High clinical suspicion is required for timely diagnosis as common investigations routinely done for gastrointestinal (GI) bleeding, including esophagogastroduodenoscopy, fails to detect most cases. The classical triad of midthoracic pain, herald bleeding and fatal hematemesis described in this condition is seen in only one-third of cases. Physician should be wary of this condition, especially in elderly patients with uncontrolled GI bleeding and who are also at risk of thoracic aneurysm. Computed tomography angiogram detects most cases and emergent endovascular repair with stents controls the initial bleeding. Later, both the aorta and the esophagus are repaired and reconstructed in staged procedures.

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“…An aortoesophageal fistula after an esophageal SEMS insertion for an esophageal benign disease has rarely been reported and only in cases where there was an esophageal stricture [9,10] . More recently, the management of aortoenteric fistulas has been via thoracic endovascular aortic repair to control bleeding in the acute setting, either as a stand alone procedure or combined with a more definite management in an elective setting [11] . Other management strategies include endovascular aortic repair and subtotal esophageal resection followed by gastroesophageal reconstruction or open thoracic surgery [11] .…”

Section: Discussionmentioning

confidence: 99%

“…More recently, the management of aortoenteric fistulas has been via thoracic endovascular aortic repair to control bleeding in the acute setting, either as a stand alone procedure or combined with a more definite management in an elective setting [11] . Other management strategies include endovascular aortic repair and subtotal esophageal resection followed by gastroesophageal reconstruction or open thoracic surgery [11] . The advantage of the former approach compared to the stand alone endovascular aortic repair is that, although it controls bleeding acutely, there is a higher probability of graft infection and mediastinitis given that the esophageal defect is not corrected [12] .…”

Section: Discussionmentioning

confidence: 99%

Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

Almadi

Bamihriz

Aljebreen

2013

WJGS

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Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents (SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwent a computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Stents; Esophagus; Leak; Surgery; Complication; Aortoesophageal fistula; Endoscopy; Bariatric surgery; Sleeve gastrectomy Core tip: One modality for managing staple line leaks after laparoscopic sleeve gastrectomies depends on a non-surgical approach, including elimination of oral intake, parenteral nutrition, use of broad spectrum antimicrobial therapy, drainage procedures and the use of esophageal self-expandable metal stents for sealing these leaks and the induction of tissue hyperplasia that would close these defects. Although this seems as a less invasive procedure when compared to a repeated surgical procedure and there is a body of evidence in the literature that supports such an approach, it is not void of complications. Here we report a fatal aortoesophageal fistula as a complication.Almadi MS, Bamihriz F, Aljebreen AM. Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy.

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Management options for aorto-oesophageal fistula: case histories and review of the literature

Cited by 17 publications

References 10 publications

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

Aorto‐esophageal fistula: the multi‐disciplinary team approach to management

Primary aorto-esophageal fistula: Great masquerader of esophageal variceal bleeding

Fatal aortoesophageal fistula bleeding after stenting for a leak post sleeve gastrectomy

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