Intractable esophago-mediastinal fistula as a rare complication following thoracoabdominal aortic replacement

Abstract

Although occurring infrequently, esophagomediastinal fistula is potentially life-threatening. We report a rare case of intractable esophago-mediastinal fistula following thoracoabdominal aortic replacement. A 62-year-old male patient with aortic dissection underwent thoracoabdominal aortic replacement. He suddenly developed septic shock with esophageal perforation on the 6th postoperative day. Conservative therapy was employed, and he was discharged from the hospital. However, he suffered another attack of septic shock resulting from an esophago-mediastinal fistula. Gastrointestinal endoscopy revealed a suture thread beside an esophageal fistula. The patient consequently underwent esophagectomy. After removal of the esophagus, we found a suture thread with pledgets in the mediastinum and removed it. He recovered successfully thereafter. Esophago-mediastinal fistula associated with pledgets is a rare complication of thoracoabdominal aortic replacement. We believe that radical surgery can be an effective treatment. A review of the current literature did not reveal any similar cases. In this report, we discuss the clinical course of such a rare case.

Seven esophageal perforation cases after aortic replacement/stenting for thoracic aortic dissection or aneurysm

“…Esophageal perforation after aortic replacement or stent grafting for aortic dissection or aneurysm is a rare but potentially fatal complication. However, its cause, standard treatment, and prognosis are unclear [ 1 – 3 ].…”

“…However, it is unclear whether the definition of AEF includes esophageal perforation after aortic replacement, as artificial grafts do not fistulize. In fact, most AEF-related papers are about cases after thoracic endovascular aortic repair (TEVAR) procedure [ 3 – 5 ].…”