Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer

Abstract

Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished.

pTEVAR of an aorto-esophageal fistula in esophageal cancer: Case report and review of the literature

“…4 patients were alive during follow-up, 2 died during intervention and the average survival time of the rest was 3.9 months [15] . It seems that exposure to radiotherapy with doses higher than 35 Gy and implantation of esophageal stents in the medical history are risk factors for developing AEF [6 , 13] . In 9 patients, TEVAR was performed to cover the fistula without any further intervention [4 , 7 , 15 , [17] , [18] , [19] , [20] ].…”

“…Esophageal stenting in addition to TEVAR was performed in 7 cases. Until now it remains unclear whether stenting before or after TEVAR is more efficient [2 , 6 , 13 , 16] .…”

“…The use of antimicrobial coatings on the surface of stent grafts is another option to and discussed for the future [2 , 4 , 6] . Considering these limitations, TEVAR for AEF may need subsequent open repair [6 , 13 , 14] .…”

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

“…There are only 12 reports of 19 cases of primary AEF due to esophageal cancer treated by TEVAR in PubMed written in English[ 1 , 2 , 19 , 21 - 29 ]. Table 1 shows the clinical features of the patients in previous studies and those of the present case[ 1 , 2 , 19 , 21 - 29 ]. Of these 20 cases, 4 were women and 16 men.…”

Aortoesophageal fistula with formation of secondary aortic pseudoaneurysm due to esophageal neoplasia: case report

“…It is a catastrophic condition that requires immediate treatment due to its high mortality rate. Thoracic aortic aneurysm, foreign body ingestion, esophageal malignancy and post-surgical complications are common causes of AEF [1,2]. However, radiationinduced AEF is a rare phenomenon, and little described in the literature, but with high lethality even in specialized centers and with immediate therapy, making prevention the best option [3][4][5].…”