Endovascular Treatment of Aortoesophageal Fistula Caused by Ingestion of a Fragment of Beef Bone: Case Report and Review of the Literature

Abstract

Context: Aortoesophageal fistula is a rare but catastrophic complication that can occur either primarily or after aortic reconstruction. Because of its rarity, no standardized protocols for its diagnosis and treatment have been established. Objective: The objective of this study was to report on a case of aortoesophageal fistula caused by a fragment of beef bone, which was treated by means of an endoprosthesis in the descending thoracic aorta to control the bleeding. Case report: A 72-year-old female patient was initially admitted to the emergency service of a public hospital with dysphagia and intense pain in the dorsal region after having ingested a fragment of beef bone. Upper digestive endoscopy was performed to remove the foreign body. Nine days after the patient had been released, she was again admitted to the emergency service with back pain, voluminous hematemesis and signs of hypovolemia. Emergency angiotomography was performed, which revealed the presence of a pseudoaneurysm in the thoracic aorta just below the aortic arch that was suggestive of an aortoesophageal fistula. The patient was taken to the hemodynamics center and underwent an endovascular procedure to insert an endoprosthesis into the descending thoracic aorta, to control the bleeding. She was released after a hospital stay of 94 days, without further signs of infection or aortic bleeding. She evolved without symptoms during a follow-up of around 30 days, but then returned to the emergency service with persistent fever and signs of sepsis. She underwent left thoracotomy for drainage and debridement, but her condition worsened and she died during the immediate postoperative period. Conclusion: Aortoesophageal fistula is a serious clinical condition that needs to be dealt with early on, because of the risk of severe blood loss. Endovascular treatment is very important in this regard, since it promotes control over bleeding through an efficient and less invasive approach.