title: Aortobronchial fistula resulting from a mycotic pseudoaneurysm after treatment of an aortoesophageal fistula due to a thoracic aortic aneurysm.
abstract: A 58-year-old man was admitted for an aortoesophageal fistula (AEF) resulting from a thoracic aortic aneurysm. He underwent immediate in-situ prosthetic graft replacement, primary esophageal repair and wrapping of the aneurysm. Postoperative upper gastrointestinal endoscopy and computerized tomography (CT) findings were unremarkable. He was discharged on postoperative day (POD) 25. Three months after surgery, he was readmitted with complaints of worsening cough and hemoptysis. CT showed a thrombosed aneurysm adjacent to the left bronchus. Aortobronchial fistula due to mycotic pseudoaneurysm was suspected. The patient underwent immediate resection of the infected graft and prosthetic graft replacement positioned to avoid the infected area. The graft was wrapped with omentum. On POD 7, pleural empyema developed, and esophagography revealed a residual leak. Staged reconstruction of the esophagus was performed successfully. We conclude that even if the fistulous opening is small, simultaneous esophageal resection should be performed during the initial treatment of AEF.
authors.affiliation: Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Koji
authors.initials: K
authors.lastname: Kawahito
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Murata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
mesh_terms: D017541:Aneurysm, False / Q000150:complications / Q000209:etiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000209:etiology / Q000601:surgery*