Combined endovascular stent grafting and endoscopic injection of fibrin sealant for aortoenteric fistula complicating esophagectomy.
A 67-year-old man with previous total gastrectomy and roux-en-Y esophagojejunostomy had hematemesis 4 weeks after esophagectomy performed because of carcinoma of the esophagus. Investigation showed an aortojejunal fistula with a thoracic aortic pseudoaneurysm. Endovascular stent grafting of the pseudoaneurysm, followed by endoscopic injection of fibrin sealant for the fistula, was performed, and the infection was controlled with broad-spectrum antibiotic agents together with drainage and daily irrigation of the pseudoaneurysm sac. The fistula subsequently healed. The patient remained well 14 months after the procedure; follow-up computed tomograms at 12 months did not show any pseudoaneurysm, and there was no evidence of reopening of the fistula.
Mok
Vivian W K
VW
Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China.
Ting
Albert C W
AC
Law
Simon
S
Wong
Kam Ho
KH
Cheng
Stephen W K
SW
Wong
John
J
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D017541:Aneurysm, False / Q000209:etiology / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000628:therapy; D001018:Aortic Diseases / Q000209:etiology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004322:Drainage; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D008297:Male; D015607:Stents; D007507:Therapeutic Irrigation; D013908:Thoracotomy; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive