Successful treatment of an aortoesophageal fistula after emergency endovascular thoracic aortic stent-graft placement.
We report the case of a 57-year-old man who underwent emergency stent-graft placement in August 2003 due to a contained rupture of a distal descending aortic aneurysm. After 1 month the patient was readmitted with chest pain as well as swallowing disorders. A computed tomographic scan revealed a fistula between the distal esophagus and the excluded aneurysm sac. The patient was treated by an esophagectomy, a cervical esophagostomy, as well as a feeding gastrostomy. The infectious parietal thrombus was partially debrided and the aneurysm sac was filled with vancomycin. After 3 months continuity was reinstalled with a pedicled isoperistaltic transverse colonic conduit. The patient recovered uneventfully. At a 3 month follow-up, he showed no signs of infection. However, he is still being treated with antibiotic therapy of ciprofloxacin for a minimum of 1 year.
Czerny
Martin
M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. bypass@eunet.at
Zimpfer
Daniel
D
Fleck
Tatjana
T
Gottardi
Roman
R
Cejna
Manfred
M
Schoder
Maria
M
Lammer
Johannes
J
Wolner
Ernst
E
Grabenwoger
Martin
M
Mueller
Michael-Rolf
MR
D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D004937:Esophageal Fistula / Q000209:etiology* / Q000601:surgery*; D016629:Esophagectomy; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000209:etiology* / Q000601:surgery*