PS01.112: ESOPHAGEAL AORTIC FISTULA TREATED BY ESOPHAGOSCOPY COMBINED WITH AORTIC ENDOVASCULAR GRAFT EXCLUSION

Abstract

Abstract Background The esophageal aortic fistula is an uncommon disease caused by a foreign matter in the esophagus. This condition presents a high mortality, and inappropriate treatment can result in serious consequences. Methods A 66-year-old male patient was admitted to a hospital because of frequent dysphagia and severe chest pain after eating fishbone 5 days ago. In another hospital, the patient underwent gastroscopy, which revealed that a fishbone was incarcerated in the esophageal wall 23 cm away from the incisor and was causing active bleeding. The fishbone was not successfully removed in this hospital. A CT scan of the thorax performed in our department indicated an esophageal striped high-density shadow (below the aortic arch). The borders of the thoracic aortic wall were unclear. On the basis of these findings, the patient was diagnosed with esophageal aortic fistula. The doctors in the otolaryngology department failed to remove the fishbone by esophagoscopy because of jet-like bleeding. An esophageal gasbag was immediately used for hemostasis by compression. Afterward, thoracic surgeons performed ascending aorta angiography, which showed an approximately 1.0 cm anabrosis in the lesser curvature of the initial part of the descending aorta. The covered stent was placed, and the fishbone was removed successfully by esophagoscopy. Results The patient was able to eat normally after 7 days postoperatively. No significant abnormality was reported in the following 3 years. Conclusion An esophageal aortal fistula caused by a foreign matter should be operated on immediately if the physical condition of the patient permits. The location of the foreign matter and its relationship to the large blood vessels can be detected by high-resolution computed tomography and computed tomography angiography. Stent implantation reduces the risk of massive hemorrhage. Therefore, we recommend esophagoscopy combined with aortic endovascular graft exclusion as a safe alternative. Disclosure All authors have declared no conflicts of interest.