Peptic Ulcer-Induced Acute Aortogastric Fistula Occurring 7 Years After a Pharyngogastrostomy Following a Resection for Carcinoma of the Esophagus: Report of a Case

Abstract

A 46-year-old woman underwent a pharyngogastrostomy, following a laryngoesophagectomy for esophageal carcinoma. Although she had been disease-free for 7 years, she subsequently was admitted to undergo a workup due to fever along with chest and back pain. A few days after admission, the patient suddenly vomited a large volume of blood and went into shock. Bleeding was stopped with a Sengstaken-Blakemore tube, and an emergency thoracotomy was performed. A fistula between the thoracic aorta and an ulcer of the gastric tube was identified. We decided to close the aortic lesion directly because the adhesions were extremely dense and her blood circulation was poor. One week later, we resected the thoracic part of the gastric tube, debrided the fistula, and wrapped the aortic lesion with a patch. However, on the 18th postoperative day, she developed massive hematemesis due to rupture of an infected pseudoaneurysm in the thoracic aorta and died.

Emergent interventional approach for aortogastric tube fistula with massive gastrointestinal bleeding

“…Several studies have reported the interval between oesophagogastrectomy and haematemesis in patients with anastomotic leakage to range from 11 to 80 days. This interval is shorter than that for patients who develop peptic ulcers, for whom the interval ranges from 14 months to 7 years 1. The specific case reported here occurred 14 years after oesophagogastrectomy.…”

“…Aortogastric fistula is a very rare condition, particularly in association with gastric tube complications following oesophagectomy 1 2. Such injuries to the aorta are rarely observed, and commonly result in rapid exsanguination and a high mortality rate 1–3.…”

“…Such injuries to the aorta are rarely observed, and commonly result in rapid exsanguination and a high mortality rate 1–3. Twenty-one cases of aortogastric fistula have been reported in the literature, and only one patient survived after undergoing surgery and endovascular stent graft placement 1 2. Immediate intervention is the sole option for saving patients with this condition 2.…”

Gastric tube perforation after esophagectomy for esophageal cancer

“…51 Indeed, most of the reported cases of gastric tube ulcers did not involve pain, [7][8][9][10][11][12][13][14][15][16][17][18][51][52][53][54] so that ulcers of the gastric tube may be less frequently painful than ordinary gastric ulcers. However, the mechanism of ulcer pain remains controversial.…”

“…[7][8][9][10][11][12][13][14][15][16][17] The characteristics of the cases of perforated gastric tube after esophagectomy for esophageal cancer are presented in Table 1. Cases #6 12 and #11 15 had been taking an H2-blocker and nonsteroidal anti-infl ammatory drugs (NSAIDs), respectively, before the gastric tube was perforated, and the latter patient had a history of gastric ulcers.…”