Aortoesophageal Fistula: Report of an Unusual Case

Abstract

We report herein the case of a patient with an aortoesophageal fistula (AEF) who was managed successfully by surgery. A 5-mm oval, well circumscribed aortic perforation just above the orifice of the celiac axis and a 4-mm defect in the esophagus were primarily closed, and an omental flap was placed between the aorta and the esophagus. No definite etiology could be determined. Our experience of this case suggests that primary closure for defects in both the aorta and the esophagus is the best option when the defects are small, and that the possibility of an AEF must be considered in patients with midthoracic pain or hematemesis, even if there is no history of thoracic aortic aneurysm, foreign body ingestion, trauma, or esophageal disease.

Primary aortoenteric fistula

“…In 30 of these patients CT images were interpreted as proof or suggestive of a PAEF (for example, air within aortic wall24, 32, 47, 65, 66 ( Fig. ), focal bowel wall thickening, disruption of aortic fat cover12, 27, 34, 45, 59 ( Fig. )).…”

“…The mortality rate of patients undergoing in situ grafting without the use of an antibiotic‐soaked graft was 36 per cent (14 of 39). Eight patients were treated with closure of the gastrointestinal defect, without the use of a graft2, 26, 27, 37, 44, 46, 59, 72, but six died in the postoperative period, four from overwhelming sepsis and two from anastomotic leakage.…”

What’s new in the pathology, pathophysiology and management of benign esophageal disorders?

“…Esophageal resection in delayed cases has the advantage of eliminating the source of sepsis, the perforation and the affected esophagus 450 . Several reports have appeared concerning the diagnosis and management of an aorto‐ or arterioesophageal fistula 451 –456 …”

Aortic squamous metaplasia in a patient with aortoesophageal fistula secondary to thoracic aortic aneurysm: An autopsy case

“…8 Esophageal perforation in patients with AEF has sometimes been managed by wide resection with staged restoration of gastrointestinal continuity. 6 In cases with small defects of both the aorta and the esophagus, primary repair was reportedly effective; 9 however, the reports on successful treatment are still limited because of emergency conditions associated with gastrointestinal bleeding and possible infection of the aortic lesion. 3,10,11 In this report, we present the autopsy findings of a case of AEF.…”