Aortoesophageal fistula: A case report

Abstract

Introduction: Aortoesophageal fistula (AEF) is a rare and potentially lethal cause of upper gastrointestinal bleeding. Although several causes have been implicated in this condition, a ruptured thoracic aortic aneurysm remains the most common cause. Despite the challenge of differential diagnosis, this is a situation that requires prompt action with immediate hemorrhage control. Case Report: We report a case of a 56-year-old woman who presented with hemorrhagic shock secondary to AEF with no underlying cause identified, treated with Thoracic Endovascular Aortic Repair (TEVAR) after immediate bleeding control with a Sengstaken–Blakemore (SB) tube. Post-operatively the patient developed pneumonia and operative wound infection that were treated conservatively. At 24 months follow-up, the patient is asymptomatic and there is no clinical, analytical, or imagiological evidence of vascular graft infection. Conclusion: Survival outcomes have improved with the advent of endoluminal aortic stent therapies and TEVAR is currently considered a viable approach for AEF bleeding control in the emergency setting for unstable patients. However, long-term concerns remain since TEVAR is not a definitive treatment for AEF defect, leaving the patients at risk for AEF recurrence but also for stent graft infection. Resection of the esophagus with restoration of gastrointestinal continuity and vascular reconstruction can be performed in a one or two stage procedure and is the definitive treatment for AEF.