Foreign body ingestion is a common emergency presentation; however, aortic pseudoaneurysm and aortoesophageal fistula (AEF) secondary to fish bone ingestion are exceedingly rare. We report a case of thoracic aortic pseudoaneurysm and AEF caused by a fish bone. A 43-year-old male presented with chest pain one week after ingesting a fish bone. Clinical findings included fever, tachycardia, leukocytosis, elevated C-reactive protein, and anemia. Computed tomography angiography revealed a fish bone adjacent to a 27×17 mm thoracic aortic pseudoaneurysm. Due to hemodynamic instability, emergent zone 2 thoracic endovascular aortic repair (TEVAR) was performed, followed by endoscopic removal of the fish bone, nasogastric tube placement, and mediastinal drainage via mini-thoracotomy. Aortic pseudoaneurysm resulting from fish bone ingestion is life-threatening. TEVAR provides life-saving hemorrhage control in unstable patients, allowing subsequent definitive management.

Aortoesophageal fistula (AEF) is a relatively rare and life-threatening condition, and the optimal surgical treatment for secondary AEF following thoracic endovascular aortic repair (post-TEVAR AEF) remains controversial. This study aimed to summarize the clinical efficacy of aortic arch debranching combined with extra-anatomic bypass for the treatment of post-TEVAR AEF. The clinical data of 16 patients who underwent surgical treatment for post-TEVAR AEF at our institution from 30 June 2019 to 30 June 2024 were retrospectively reviewed. Aortic arch debranching and extra-anatomic aortic bypass under general anesthesia were performed for most patients. Empirical antibiotics were administered for 6-8weeks. The acute and long-term outcomes were summarized. Stent-related infection leading to AEF occurred at a median interval of 30months after the initial TEVAR surgery. All patients presented with recurrent fever preoperatively; blood bacterial cultures were positive in nine patients (56.25%) and negative in seven patients (43.75%). The median operative time was 460.5 (433.5, 543.5) minutes, and the median intensive care unit stay was 7 (5.25, 31.75) days. No intraoperative mortality was observed in this cohort. During the follow-up period, three patients developed recurrent AEF accompanied by severe infection. Four patients died postoperatively, including one who died of thoracic aortic rupture and hemorrhage within 3months postoperatively, and three others died of multiple organ failure at 4-10weeks after surgery. The remaining 12 patients achieved favorable postoperative recovery without the need for prolonged antibiotic therapy. Aortic arch debranching and extra-anatomic bypass from the ascending aorta to the proximal abdominal aorta yields favorable acute and long-term outcomes for patients with post-TEVAR AEF.

Esophageal Band Ligation Successfully Controlled Sentinel Bleeding From an Aortoesophageal Fistula.

Aortoesophageal fistula (AEF) is a rare but invariably life-threatening conditio. The optimal treatment for AEF resulting from postoperative anastomotic leakage following esophageal cancer surgery remains a significant clinical challenge. Here, we report a detailed case of AEF caused by anastomotic leakage from a thoracic esophageal anastomosis after esophageal cancer resection, which was successfully managed with emergent thoracic endovascular aortic repair (TEVAR) for hemorrhage control, followed by elective surgical intervention comprising esophagogastric re-anastomosis and aortic fistula repair with a bovine pericardial patch. The patient achieved long-term survival. A 68-year-old male underwent minimally invasive McKeown esophagectomy with intrathoracic esophagogastric anastomosis after neoadjuvant chemotherapy and immunotherapy for advanced esophageal squamous cell carcinoma (SCC). Postoperatively, the patient experienced fever followed by hematochezia and hematemesis. Emergency endoscopy was unsuccessful in controlling the active arterial bleeding at the inflamed anastomotic site. Enhanced CT angiography (CTA) did not reveal a definitive aortoesophageal fistula, and subsequent transarterial embolization of the right gastric artery (confirmed by procedural records) failed to control the condition. The patient developed hemorrhagic shock manifested by loss of consciousness and hypotension. A repeat enhanced CT scan revealed active contrast extravasation from the descending aorta into the gastric conduit. An emergency TEVAR was performed to stabilize the hemodynamics. On postoperative day 10, we performed surgical exploration, which confirmed resection of the esophagogastric anastomotic leak, direct repair of the aortic wall defect, and reconstruction via esophagogastric anastomosis with the remnant stomach. Intraoperatively, a stapler clip from previous endoscopic hemostasis was identified as the potential culprit for the fistula formation. Ten months after the onset of AEF, the patient continued chemotherapy and led a normal daily life. This case underscores that TEVAR is an effective and life-saving hemostatic method for managing life-threatening hemorrhage from AEF. However, TEVAR alone cannot ensure long-term survival due to its inability to control the underlying infection and address the gastrointestinal defect. Long-term survival requires subsequent definitive surgical repair of both the esophageal and aortic components.

Aortoesophageal fistula as a late-onset complication of infected aortic arch aneurysm caused by Salmonella enterica serotype Choleraesuis: a case report.

Button battery ingestion (BBI) in toddlers is a paediatric emergency requiring immediate endoscopic or surgical intervention, as delayed treatment can be fatal. The ideal removal window is within 2 hours, but this is often missed due to nonspecific symptoms. Prolonged exposure to the battery's corrosive effects can cause severe complications, including tracheoesophageal fistula (TEF) and aortoesophageal fistula (AEF), which may be fatal. Reported the case of a 2-year-3-month-ol d boy who presented to the Emergency Department three days after ingesting a 3×3 cm button battery. His non-specific symptoms led to a missed diagnosis during an earlier visit to a general practitioner. Diagnosing the condition was further complicated by the absence of significant findings on physical examination. However, a detailed history revealed the sudden onset of symptoms and an episode of unsupervised play before symptom onset, raising suspicion of foreign body ingestion. An immediate anteroposterior and lateral neck and chest X-ray confirmed the diagnosis.The button battery was successfully removed endoscopically. However, the delayed presentation resulted in complications, including mucosal injuries and pus collection. The patient received intravenous fluids, antibiotics, and steroids to prevent further complications. In this case, the child’s non-citizenship status and financial constraints posed additional challenges to proper post-removal monitoring and surveillance. This case report highlights the importance of early recognition of BBI in high-risk groups as a paediatric emergency and emphasizes the need for diligent post-removal surveillance. Ultimately, this report underscores the critical role of timely intervention and preventive measures in such cases.

Background: Esophageal foreign body (EFB) impaction is a frequent emergency department presentation. While many cases involve witnessed, low-risk ingestions, significant diagnostic and therapeutic challenges arise when clinical history is incomplete, as in young children or cognitively impaired individuals. The risk spectrum is broad, ranging from spontaneous passage to life-threatening complications like perforation or aortoesophageal fistula. Aim: This article reviews the etiology, epidemiology, pathophysiology, and management of EFB impaction, highlighting the complexities faced in emergency settings and outlining evidence-based strategies for evaluation and intervention. Methods: A comprehensive review synthesizes current clinical knowledge on EFB impaction. It examines age-related epidemiological patterns, the pathophysiology of impaction at physiological narrowings, and the specific mechanisms of injury from high-risk objects like button batteries, magnets, and sharp items. Diagnostic approaches, including radiography and computed tomography, and therapeutic algorithms are detailed. Results: Management is dictated by patient stability, object type, location, and dwell time. Endoscopic removal is the cornerstone of treatment, with success rates >90%. Button batteries in the esophagus require emergency removal due to rapid caustic injury. Most blunt objects pass spontaneously, but food impactions in adults often indicate underlying pathology (e.g., strictures, eosinophilic esophagitis), necessitating further evaluation. Conclusion: Successful outcomes rely on prompt recognition of high-risk scenarios, timely endoscopy, and understanding object-specific risks. A coordinated, interprofessional team approach from triage through discharge and prevention counseling is essential to minimize morbidity.

The patient was a 79-year-old man diagnosed with thoracic esophageal cancer(cT4[aorta]N1M0, Stage ⅣA)and received preoperative chemoradiotherapy(2 courses of fluorouracil and cisplatin and 40 Gy of radiation). Despite treatment, the aortic invasion did not improve, and an additional 20 Gy of radical radiation was administered. Ten days after treatment completion, the patient presented with hematemesis. An upper gastrointestinal endoscopy demonstrated a suspected aorto- esophageal fistula(AEF). The patient underwent thoracic endovascular aortic repair(TEVAR)urgently. Thirty-five days later, the general condition improved, and he underwent thoracoscope-assisted subtotal esophagectomy, omental patch to the mediastinum, esophagostomy, and gastrostomy. The pathological diagnoses were CRT-pT4b(aorta and trachea), RM1, pN1, M0, and pStage ⅣA. Postoperatively, the patient developed a persistent mediastinal abscess that was relieved with drainage and antibacterial treatment. Chemotherapy was initiated as the residual disease increased, and multiple pulmonary metastases appeared. Ten months after the TEVAR, the patient remained alive. We suggest that TEVAR followed by esophagectomy is effective in treating AEF associated with locally advanced esophageal cancer.

Rationale:Aortoesophageal fistula (AEF) following thoracic endovascular aortic repair (TEVAR) is a rare but highly fatal complication. Despite successful initial repair, factors such as large aneurysms and mediastinal hematoma may lead to persistent esophageal compression and ischemia, culminating in delayed AEF. This report presents 2 fatal cases to highlight the diagnostic challenges and management pitfalls of this condition, underscoring the need for increased vigilance in high-risk patients even after successful procedures.Patient concerns:Case 1: A 60-year-old male was hospitalized after a traffic accident with multiple injuries, including a pseudoaneurysm of the aortic arch. Over an 8-day interval, its size expanded from 3.7 × 2.5 cm to 6.6 × 6.0 × 4.8 cm. He underwent TEVAR but developed postoperative dysphagia and died suddenly at home 22 days after discharge due to massive hematemesis. Case 2: A 53-year-old male presented with acute chest and back pain accompanied by lethargy. Imaging revealed a giant thoracic aortic aneurysm (10.8 × 9.2 × 16.1 cm) compressing the esophagus and trachea. Emergency TEVAR was performed, but he returned 50 days later with cough, fever, dyspnea, and severe anemia.Diagnoses:Both patients were confirmed to have AEF. In Case 1, autopsy revealed a 3.5 × 2.0 cm mid-esophageal rupture. Case 2 was diagnosed via computed tomography angiography, which showed a 5.0 cm fistulous tract between the aorta and esophagus.Interventions:Both patients underwent emergency TEVAR using fenestrated stent grafts. After AEF development, Case 2 received transfusions (8 units of packed red blood cells) and broad-spectrum antibiotics but declined further surgical intervention. Case 1 did not receive any intervention prior to his death.Outcomes:Both patients died from exsanguination due to AEF: Case 1 at 22 days and Case 2 at 50 days after initial surgery. Neither patient underwent definitive surgical repair of the fistula.Lessons:AEF should be suspected in TEVAR patients with risk factors like large aneurysms or mediastinal hematoma, especially if new symptoms such as dysphagia or fever appear weeks later. Prompt CT angiography is critical. Non-operative management is fatal, and only aggressive surgery offers a potential cure. Prevention requires meticulous stent sizing and measures to reduce infective and mechanical risks.

This review summarizes anesthetic challenges in up-to-date developments of cognitive aids in thoracic anesthesia emergencies. Recent advancements demonstrate a progression toward structured, algorithm-driven approaches that mitigate cognitive overload, enhance team coordination, and support clinical decision-making during rare, high-stakes events such as massive hemoptysis, tracheobronchial obstruction, mediastinal mass syndrome, or pericardial tamponade. Evidence highlights that cognitive aids - ranging from checklists and flowcharts to simulation-based mnemonics - improve recall, technical performance, and interdisciplinary communication, thereby reducing errors and omissions of essential steps in the acute setting, although they cannot substitute clinical judgement. While several conditions, including massive hemoptysis and mediastinal masses, are supported by structured frameworks, others such as bronchopleural fistula, aortoesophageal fistula, or diaphragmatic rupture still lack standardized tools and yet depend largely on institutional case-based experience and expert opinion. Well-designed cognitive aids facilitate critical priorities such as airway protection, bleeding control, and hemodynamic stabilization, and guide complex multidisciplinary interventions like bronchial artery embolization or thoracic endovascular aortic repair. Their successful use requires appropriate design and thoughtful integration into local practice, simulation training, and crisis resource management. Future efforts should focus on systematic development and validation of specialty-specific tools to optimize patient outcomes and strengthen resilience in thoracic anesthesia crisis management.

ObjectivesThoracic aortic infection (TAI), including infections of the native aorta, prosthetic graft infections, aortoesophageal fistula, and aortobronchial fistula, remains among the most challenging and fatal diseases. This study aimed to review our 25-year experience with surgical management of TAI.MethodsThis retrospective study included 106 participants with TAI from January 2000 to September 2024. The primary end point was hospital mortality. Secondary end points included 30-day mortality, trends in TAI management, overall survival, freedom from infection-related death, and freedom from infection-related events. Subgroup analyses were also conducted. The current surgical strategy has been in use since 2008.ResultsAmong 106 participants, 33 (31.1%) had aortoesophageal fistula, 7 (6.6%) had aortobronchial fistula, and 66 (62.2%) had TAI without fistula. Eighty-four participants underwent surgery after 2008. In situ replacement was performed in 85 (80.1%), thoracic endovascular aortic repair in 15 (14.1%), and extra-anatomical bypass in 6 (6%). The 30-day mortality rate was 3.7% (n = 4), and hospital mortality was 16.0% (n = 17). At 10 years, overall survival was 55.4% ± 5.9%, freedom from infection-related death was 78.7% ± 4.3%, and freedom from infection-related events was 76.1% ± 4.4%. Participants who underwent surgery after 2008 had significantly better outcomes than those treated before 2008.ConclusionsDespite the continued high hospital mortality associated with surgical treatment of TAI, the strategy implemented since 2008 has resulted in improved outcomes. The long-term outcomes were acceptable.

Management of Endograft Infection after Thoracic Endovascular Aortic Repair.

Introduction: Aortoesophageal fistula (AEF) is a rare but acutely life-threatening condition. In a study involving 123 surgically treated cases, 61% were secondary AEFs—most commonly due to aortic grafting (32.5%), followed by thoracic endovascular aortic repair (TEVAR) (24.4%). Other reports have identified esophageal cancer as a cause. We present a case of AEF secondary to an infected TEVAR graft in a patient with recent type B thoracoabdominal aortic dissection and aneurysm. Case Description/Methods: A 68-year-old Asian man with a remote history of type A aortic dissection status post surgical repair, recent hx of type B thoracoabdominal dissection and aneurysm status post 2 TEVARs, and chronic urinary obstruction managed with a suprapubic catheter (SPC), was admitted for evaluation of a urinary tract infection (UTI). He had been well until 1 week prior, when he developed fever, chills, and dysuria. His SPC was exchanged, and a 5-day course of oral ciprofloxacin resolved the fever, though urinary symptoms persisted. On admission, he was started on intravenous cefepime and vancomycin. Blood cultures grew Gemella haemolysans. Two days later, he had hematemesis with a hemoglobin drop from 9.9 to 6.9 g/dL. esophagogastroduodenoscopy showed an esophageal ulcer with recent bleeding in the mid-esophagus. CTA revealed multifocal gas within the aneurysm sac and false lumen around the stent graft, consistent with an aorto-esophageal fistula (AEF). Vascular surgery was consulted, but due to his frailty, graft explantation was deferred. He was transitioned to comfort care and passed away the following day. Discussion: AEF is an extremely rare but critically life-threatening condition. Reported outcomes in a series of 10 patients with TEVAR graft infections complicated by AEF had a perioperative mortality rate of 70%. Seven of the 10 patients died from hemorrhage and infection, and only 3 survived to hospital discharge. In our case, the patient developed bacteremia from a urinary tract infection, which led to graft infection and subsequently resulted in an AEF. Clinicians should maintain a high index of suspicion for AEF in patients presenting with hematemesis, particularly those with a history of aortic surgery, thoracic aortic aneurysm, TEVAR, or thoracic and gastrointestinal malignancies.

Introduction: Aortoesophageal fistula (AEF) is a rare but often fatal cause of upper gastrointestinal bleeding. Although classically associated with thoracic aortic aneurysms or esophageal malignancy, iatrogenic causes—including surgical interventions and foreign body erosion—are increasingly recognized. Case Description/Methods: A 30-year-old woman with a history of alcohol use disorder, prior hiatal hernia repair, and partial gastrectomy complicated by esophageal necrosis presented with sudden, massive hematemesis. A Malecot drain had been placed postoperatively within a blind esophageal pouch. On arrival, she was tachycardic and hypotensive (BP 64/37 mmHg; MAP 43) with ongoing hematemesis, necessitating intubation and vasopressor support. Laboratory data revealed a hemoglobin of 7.5 g/dL and lactate of 5.7 mmol/L. Computed tomography angiography revealed the Malecot drain terminating in the blind esophageal pouch with contrast extravasation suggesting communication with the descending thoracic aorta. Despite urgent vascular surgery consultation and preparations for thoracic endovascular aortic repair (TEVAR), the patient experienced refractory shock and died from cardiac arrest. Discussion: AEF is exceedingly rare (<0.007% in autopsy series), with most cases due to aneurysms (54%), malignancy (19%), or foreign body ingestion (17%). Iatrogenic cases remain a minority but are increasing. This case highlights a unique mechanism—erosion from a chronically placed Malecot drain leading to fatal fistula formation. Clinicians must maintain high suspicion for AEF in any patient with prior upper GI surgery and massive hematemesis, especially in the setting of indwelling esophageal devices.

Introduction: Upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality in hospitalized patients, with a broad differential diagnosis. While common etiologies include peptic ulcer disease and varices, rare causes such as aorto-esophageal fistula (AEF) must be considered, especially given their high mortality. AEF, often presenting with massive bleeding, requires a high index of suspicion for timely diagnosis and intervention. We present a 77-year-old woman with upper GI bleeding secondary to AEF in the setting of an infected thoracic aortic endograft. Case Description/Methods: A 77-year-old woman with a remote history of Type A aortic dissection status post thoracic aortic endovascular repair presented with fever, chills, and melena. Labs revealed a hemoglobin of 5.4 g/dL. Computed tomography chest showed a gas-containing abscess in the medial aortic hemiarch and extraluminal contrast concerning for endoleak. Given her comorbidities, she was deemed to be a poor surgical candidate and was started on broad-spectrum antibiotics for presumed graft infection. Initial upper endoscopy showed normal esophageal mucosa and inflamed, ulcerated gastric mucosa without active bleeding. On hospital day 6, she developed new-onset atrial fibrillation and was started on intravenous heparin. Hours later, she experienced massive hematemesis. Repeat endoscopy revealed active bleeding in the upper esophagus with a large submucosal hematoma and overlying clot, consistent with an aorto-esophageal fistula likely due to erosion from a mycotic aneurysm. Given ongoing bleeding and poor prognosis, goals of care were transitioned to comfort-focused measures. Discussion: Aorto-esophageal fistula (AEF) is an exceptionally rare but life-threatening cause of upper gastrointestinal bleeding, accounting for less than 0.1% of all cases. It is most associated with thoracic aortic aneurysms, malignancy, trauma, or complications from thoracic endovascular aortic repair. Clinical presentations are often nonspecific, typically including hematemesis, fever, and epigastric pain. This can lead to frequent delays in diagnosis. computed tomography angiography is the imaging modality of choice, while endoscopy aids in excluding other etiologies and guiding management. Despite advances in endovascular techniques, AEF carries an estimated mortality rate of 60%-90%, even with intervention. Given its rarity but high mortality, clinicians must maintain a high index of suspicion in the appropriate clinical context to enable timely recognition and improve outcomes.

ObjectivesAdvanced esophageal cancer invading the aorta is considered an unresectable disease with a poor prognosis. We evaluated the clinical impact of elective thoracic endovascular aortic repair implantation on the prognosis of such patients.MethodsWe retrospectively evaluated patients with advanced esophageal cancer and aortic invasion who underwent thoracic endovascular aortic repair to assess its prognostic impact under multimodal treatment.ResultsOverall, 124 patients were enrolled. Among these, 16 patients underwent salvage thoracic endovascular aortic repair in response to bleeding from an aorto-esophageal fistula, 46 patients received elective thoracic endovascular aortic repair with esophagectomy after diagnosing aortic invasion by a tumor, and 62 patients underwent elective thoracic endovascular aortic repair without esophagectomy after diagnosing aortic invasion by a tumor. The median overall survival time was 3.57, 6.90, and 16.90 months for patients who underwent salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair without esophagectomy, and elective thoracic endovascular aortic repair with esophagectomy, respectively (P < .001). Under multivariate analysis, compared with patients who underwent salvage thoracic endovascular aortic repair, those who received elective thoracic endovascular aortic repair with and without esophagectomy had reduced odds ratios of mortality (95% CI) of 0.21 (0.11-0.41) and 0.38 (0.20-0.74), respectively.ConclusionsCompared with salvage thoracic endovascular aortic repair, elective thoracic endovascular aortic repair implanted after diagnosis for esophageal cancer with aortic invasion is associated with improved overall survival. It provides the opportunity for esophagectomy, further prolonging survival compared with those without esophagectomy.

ABSTRACTAortoesophageal fistula (AEF) is a rare but life‐threatening condition. Initial management typically includes thoracic endovascular aortic repair (TEVAR) or aortic graft replacement to achieve hemostasis, followed by esophagectomy with aortic graft replacement and greater omentum wrapping to eliminate the source of infection. We report a case of successful endoscopic closure of a chronic esophageal fistula secondary to AEF. A 63‐year‐old man presented with hematemesis. He had a history of two ascending aortic replacements and one descending aortic replacement for aortic dissection. Computed tomography revealed a pseudoaneurysm at the graft anastomosis site and perforation into the esophagus. He was diagnosed with AEF and underwent TEVAR for hemostasis. Although the bleeding was stopped, follow‐up imaging confirmed a residual fistula. Because of his poor general condition, surgery was contraindicated, and endoscopic closure was attempted. Initial treatment with hemostasis clips was ineffective. A second attempt using polyglycolic acid sheets, fibrin glue, and hemostasis clips with endoscopic submucosal dissection (ESD) achieved closure, but the fistula reopened after 5 months. Finally, the combination of ESD and over‐the‐scope clip (OTSC) achieved complete and sustained closure. The patient was discharged after 3 months but died 8 months postoperatively owing to idiopathic splenic rupture. This case demonstrates that the combination of ESD and OTSC may be an effective treatment option for chronic esophageal fistulas caused by AEF.

ObjectiveAortoesophageal fistula (AoEF) is a rare but complex problem that carries high mortality. This study describes our institutional experience with the management of AoEF.MethodsThere were 17 patients with AoEF who were managed in our center (2005-2023). Medical records were reviewed for baseline characteristics, history of esophageal or aortic disease, diagnostic evaluation, surgical treatment, and follow-up. Overall survival (OS) was analyzed using the Kaplan-Meier method and log rank tests.ResultsMost patients had previous aortic operations (12/17, 71%)—7 thoracic endovascular aortic repair (TEVAR), 3 open/TEVAR, and 2 open repairs. The etiology of AoEF was aortic disease in 13 (76%) and anastomotic leak after esophagectomy in 4 (24%). Upon presentation, 2 (12%) patients were not offered intervention, whereas 6 (35%) had emergency TEVAR to control bleeding. Twelve (67%) patients were treated with curative intent, 1 patient did not survive an initial aortic operation. Of the remaining 11 patients, esophageal operations happened before aortic repair in 7 (64%), concurrently in 3 (27%), and after in 1 (9%). This included diversion esophagectomy in 7 (64%) and primary repair in 3 (27%). Definitive aortic surgery included aorta replacement with rifampin-soaked grafts in 8 (67%) and homografts in 4 (33%). In-hospital mortality occurred in 1 of 12 (8%) cases. One- and 2-year OS was 83% and 74%. OS was lower in patients not receiving curative-intent treatment (P < .001).ConclusionsManagement of AoEF is complex. However, aggressive multidisciplinary intervention with definitive esophageal and aortic repairs can result in good long-term survival in selected patients.

Abstract Background Over the past decade, there has been a significant increase in severe and fatal cases of esophageal burns caused by disc batteries. Possible complications include tracheoesophageal fistula, stenosis or perforation of the esophagus, paresis or paralysis of the larynx, aortoesophageal fistula. This is one of the most difficult problems in esophageal surgery in children. Methods From 2009 to 2021, 102 children with esophageal burns with a disc battery were treated. Of these, 57 boys (55.9%), 45 girls (44.1%). The median age at the time of the burn was 18 months (1 year 6 months). The battery exposure in the esophagus ranged from 1 hour to 6 months (Me = 6 hours). 57 children (55.9%) had complications. Tracheoesophageal fistula TEF in 31 (54.4%), esophageal stenosis in 24 (42.1%) and perforation in 4 (7%), laryngeal paresis or paralysis in 24 (42.1%). Statistical data was calculated using the StatTech v. 3.0.9 program. Results The group with complications was divided into: delayed surgery—36 (63.2%), primary radical surgery—21 (36.8%). Children with TEF (31) underwent 3 types of operations: fundoplication and gastrostomy—12 (38.7%; delayed tactics, TEF closed spontaneously in 7 children (58.3%)); TEF separation in the acute period—13 (41.9%; early postoperative complications—11 (84,6%)); tracheal plastic surgery using esophageal flap—6 patients (19.4%). Children with impaired laryngeal innervation required conservative management (n = 8), tracheostomy (n = 7), or lateralization operations (laryngoplasty with costal cartilage graft, Т-tube—7, suture lateralization—2). Conclusion Delayed surgical tactics demonstrate better results (16.7%) and good long-term results compared to the group which were underwent primary reconstruction immediately after of injuries. There were no statistically significant differences in the weight-for-age Z-score before surgery and in the long-term period, p = 0.345.

症例は69歳の男性で，B型亜急性の大動脈解離（aortic dissection; AD）に対して，偽腔拡大予防の胸部大動脈ステントグラフト（thoracic aortic stent graft; TA-SG）内挿術（thoracic endovascular aortic repair; TEVAR）を行った．19カ月後に発熱・倦怠感を来し，GaシンチグラフィでTA-SGにRI集積を認め，TA-SG感染と診断し抗生剤治療を行った．いったん軽快したが，その後感染の再燃で3回の入院を繰り返した．31カ月後に背部痛を来し，TA-SG末梢端のmigrationを認めたため，追加TEVARを行った．この1カ月後に，当日の抜歯後歯痛・頭痛で入院した．胸部症状はなかったが，翌日に突然心肺停止となり死亡した．剖検ではTA-SGと大動脈壁の間から排膿があり，2カ所の大動脈食道瘻（aorto-esophageal fistula; AEF）と大動脈基部破裂を認めた．TA-SG中枢端より離れた部位にエントリーを持ち，TA-SGとは無関係に発症したA型急性AD破裂と診断した．持続的な菌血症は潜在的であっても，炎症性サイトカイン発現や脈管栄養血管塞栓症などの機序で，大動脈壁に瘻孔や解離をもたらす可能性がある．本症例ではTA-SG感染による持続的な菌血症がAEFの発生に関連し，またA型急性ADを発症せしめたと考えられた．吐血などの典型的な症状が見られない場合には診断が難しいが，TEVAR後の持続的菌血症状態ではAEFを含めた，大動脈脆弱化による変化を念頭に置く必要がある．