Abstract
BackgroundAortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies. We herein report a successful one-stage hybrid treatment in a patient with AEF and arch pseudoaneurysm.Case presentationThe patient, a 40-year-old man, presented to the emergency room because of intense retrosternal discomfort for 3 days and hematemesis for 3 h. The esophagoscopy and thoracic enhanced computed tomography (CT) showed two irregular mural ulcers in the esophagus and a large saccular pseudoaneurysm at the aortic isthmus, respectively. The laboratory examinations confirmed no widespread inflammation and infection. We have successfully performed a successful one-stage hybrid treatment for this patient. Six-month follow-up shows the patient is in good condition and the esophagoscopy reveals the two mural ulcers had completely healed.ConclusionThe treatment decision-making process should depend upon the patients’ specific situations. Our case suggest the one-stage hybrid treatment could be an valuable alternative in some selected patients.
Highlights
Aortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies
Thoracic enhanced computed tomography (CT) confirmed the presence of an AEF as well as a large saccular pseudoaneurysm at the aortic isthmus, accompanied by mediastinal hematoma and bilateral pleural effusion (Fig. 1b-d)
Esophageal perforation due to foreign body ingestion is relatively unusual in adults, and is rare when it causes an abnormal communication from the esophagus to aorta (0.08%–0.14%) [2,3,4]
Summary
Aortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies. We present our successful experience in managing a patient with AEF and arch pseudoaneurysm late after removing of a chocked chicken bone by one-stage, multidisciplinary strategy of combined endovascular and open surgical approach. The patient received fasting and antibiotic treatment (intravenous Imipenem and Cilastatn Sodium [0.5 g] once per 8 h for 4 weeks) and the intraoperative cultures were negative.
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