SPONTANEOUS AORTOESOPHAGEAL FISTULA AND RUPTURED AORTIC ANEURYSM – A CASE REPORT ON COMBINED AORTIC AND ESOPHAGEAL PROSTHESIS PALLIATIVE TREATMENT

Authors

  • Diogo Castelo Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
  • Pedro Cabral Melo Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
  • Sofia Florim Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
  • Fernando Calejo Pires Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
  • Pedro Portugal Serviço de Imagiologia do Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal

DOI:

https://doi.org/10.48729/pjctvs.74

Abstract

Aortoesophageal fistulas are uncommon, dreadful vascular events, most frequently found in the setting of thoracic aorta aneurysms. Patients usually present with thoracic pain, dysphagia and sentinel hematemesis - the Chiari triad - followed by life threatening hematemesis. Emergent open surgery with debridement of necrotic tissue and in situ aortic graft repair is currently the best strategy. However, in patients which cannot withstand surgery, endovascular repair is currently gaining acceptance as a palliative treatment or as a bridge to surgery. We present a case of a 55-year-old female with a past of heavy alcohol abuse and a previously unknown massive aortic aneurysm, who presented to the emergency department complaining of acute dysphagia and epigastric pain. An abdominal ultrasound revealed left pleural effusion and suspected clots in the pleural space. A thoracic CTA was promptly done, where a spontaneous ruptured aortic aneurysm with aortoesophageal fistula was discovered. The team, fearing open surgery due to poor cardiac function, opted for a thoracic endovascular aortic repair. The aortoesophageal fistula dissected the esophageal wall in all of its thickness without rupture into the lumen. This was complicated with esophageal ischemia, aneurysmal sac infection and mediastinitis. Because the patient was in shock, in order to help control the infection, an esophageal prosthesis was placed, followed by proximal esophagostomy, distal esophageal closure and gastrostomy. Six months after initial presentation, the patient died at the emergency room, shortly after reentering with massive hematemesis and hypovolemic shock of undetermined origin.

Downloads

Download data is not yet available.

References

Hollander JE, Quick G. Aortoesophageal Fistula: A Comprehensive Review of the Literature. Am J Med. 1991 Sep;91(3): 279-87.

Akashi H, Kawamoto S, Saiki Y. Therapeutic strategy for treating aortoesophageal fistulas. Gen Thorac Cardiovasc Surg. 2014; 62:573–580

Prokakis C, Koletsis E, Apostolakis E. Aortoesophageal fistulas due to thoracic aorta aneurysm: surgical versus endovascular repair. Is there a role for combined aortic management? Med Sci Monit. 2008; 14(4): RA48-54

Chiari H. Ueber Premdkorperverletzung des Oesopha. Ber Klin Wochenschr. 1914; 51: 7–9. 7.

Göbölös L, Miskolczi S, Pousios D, et al. Management options for aortooesophageal fistula: case histories and review of the literature. Perfusion. 2013 Jul;28(4):286-90.

Flores J, Shiiya N, Kunihara T, et al. Aortoesophageal fistula: alternatives of treatment case report and literature review. Ann Thorac Cardiovasc Surg 2004 Aug; 10(4): 241-6.

Downloads

Published

25-04-2021

How to Cite

1.
Castelo D, Cabral Melo P, Florim S, Calejo Pires F, Portugal P. SPONTANEOUS AORTOESOPHAGEAL FISTULA AND RUPTURED AORTIC ANEURYSM – A CASE REPORT ON COMBINED AORTIC AND ESOPHAGEAL PROSTHESIS PALLIATIVE TREATMENT. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 25 [cited 2024 May 21];27(1):39-42. Available from: https://pjctvs.com/index.php/journal/article/view/74

Issue

Section

Clinical Cases