Bronchoesophageal fistula after endovascular repair of ruptured aneurysm of the descending thoracic aorta.
Aortoesophageal fistula secondary to thoracic aneurysm is rare and is usually fatal without prompt surgical intervention. A 79-year-old man with significant comorbidities and previous cancer surgery was admitted on an emergency basis because of the suspicion of a ruptured thoracic aortic aneurysm. Computed tomographic scan followed by angiography demonstrated a ruptured thoracic aneurysm with aortoesophageal fistula. An endovascular stent graft repair was performed with successful exclusion of both aneurysm and fistula. On postoperative day 6, dyspnea and an isolated episode of hemoptysis occurred. Endoscopy revealed the presence of a bronchoesophageal fistula, which necessitated double exclusion of the esophagus and feeding jejunostomy. At 6 months, clinical, bronchoscopic, and computed tomographic scan follow-up showed complete sealing of the aneurysm and resolution of the bronchoesophageal fistula. At 9 months, the patient was still alive but refused to undergo substernal gastric bypass in an attempt to restore oral feeding. Endovascular repair seems promising as an emergent and palliative treatment of aortoesophageal fistula. To the best of our knowledge, this is the first case in which a bronchoesophageal fistula developed after successful endovascular repair of aortoesophageal fistula. The pathogenesis of this complications remains unclear.
Bonavina
Luigi
L
Department of General Surgery, San Donato School of Medicine, University of Milano, Milan, Italy. luigi.bonavina@unimi.it <luigi.bonavina@unimi.it>
Lupattelli
Tommaso
T
Bona
Davide
D
Trimarchi
Santi
S
Nano
Giovanni
G
Rampoldi
Vincenzo
V
Inglese
Luigi
L
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D015607:Stents