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. 2024 Jul 15;3(1):34.
doi: 10.1186/s44215-024-00132-y.

Successful surgical treatment for aortoenteric fistula after esophagectomy: a case report

Erica Nishimura  1 , Hirofumi Kawakubo  2 , Asano Ryota  3 , Takeuchi Masahi  1 , Satoru Matsuda  1 , Kazumasa Fukuda  1 , Rieko Nakamura  1 , Yuko Kitagawa  1
Affiliations

Successful surgical treatment for aortoenteric fistula after esophagectomy: a case report

Erica Nishimura et al. Gen Thorac Cardiovasc Surg Cases. .

Abstract

Background: An aortoenteric fistula (AEF) is a rare and lethal complication of esophagectomy. Fistulas frequently result from problems regarding acute infections or leaks, which are typically evident weeks after the treatment. However, some cases exhibit AEF years after the initial operation. Here, we describe a rare case of AEF caused by chronic friction of the stapler toward the aortic arch, in which stent graft repair and surgery were successful.

Case presentation: A 71-year-old man had undergone esophagectomy for esophageal carcinoma and reconstruction with a gastric conduit through the posterior mediastinal route 11 years previously. He visited our outpatient clinic with the chief complaint of hematemesis. However, after arrival, he experienced massive hematemesis and severe shock due to bleeding from an AEF. Endoscopic hemostasis using a Sengstaken-Blakemore tube followed by stent graft repair controlled the bleeding. We performed a partial resection of the gastric conduit, including the fistula, followed by digestive reconstruction using a jejunal interposition graft. The patient recovered gradually after receiving intensive care and was discharged 115 days after hospitalization.

Conclusions: We present a rare case of bleeding due to AEF long after esophagectomy, which was successfully treated with endovascular stent graft repair and surgery. Endoscopic hemostasis using a Sengstaken-Blakemore tube followed by stent graft repair was effective.

Keywords: Aortoenteric fistula; Esophageal cancer; Esophagectomy; Stent graft repair.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Gastrointestinal endoscopic findings Arterial bleeding from the anterior wall of the gastric conduit has been revealed. b Arterial bleeding from the anterior wall of the gastric conduit
Fig. 2
Fig. 2
Computed tomography (CT) angiogram showing a fistula between the gastric conduit and the thoracic aorta. a Large amount of blood clots occupying the gastric conduit (red arrow). b Arterial bleeding from the anterior wall of the gastric conduit (yellow arrow)
Fig. 3
Fig. 3
Surgical findings following the resection of the thoracic part of the gastric conduit. a, b Extracting the stump of the gastric conduit from the aortic arch. The adhesion of the gastric conduit and the aortic arch was strong. c After resecting the gastric conduit. The fistula was covered with the remnant stapler (arrow)
Fig. 4
Fig. 4
Digestive reconstruction using jejunum interposition. a The isolated right internal mammary artery and vein. b Intraoperative photograph after reconstruction
See this image and copyright information in PMC

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