[Aorto-oesophageal fistula due to an aortic endovascular prosthesis: case report and state of the art].
Aorto-oesophageal fistula is a rare and often fatal condition due to pathologies of the aorta and oesophagus. Recently, a new aetiology for aorto-oesophageal fistulas has been detected, namely, decubitus of an aortic endovascular prosthesis positioned in the presence of aneurysms. The symptoms are those of Chiari's triad: (1) chest pain and/or dysphagia (2) haematemesis (3) massive haematemesis. If the patient is haemodynamically stable the gold standard diagnostic examination is a CT scan with contrast medium. Aorto-oesophageal fistulas are characterised by a rapidly worsening acute clinical presentation and high postoperative morbidity and mortality. The treatment of aorto-oesophageal fistula is divided into three progressive steps: (1) control of bleeding; (2) prevention of mediastinitis; (3) oesophageal repair. We report a case of a 59-year-old male patient with an aorto-oesophageal fistula due to the decubitus of an endovascular aortic prosthesis previously positioned for a traumatic aneurysm of the descending aorta. We controlled the bleeding in emergency with a Sengstaken-Blakemore tube. Since the cardiovascular surgeons excluded any intervention, we executed a bipolar oesophageal exclusion in our department of general surgery and subsequently positioned a self-expanding oesophageal prosthesis by a retrograde route. The patient survived for 7 months, the cause of death being septic shock.
Gentilli
Sergio
S
Clinica Chirurgica, Università del Piemonte Orientale Amedeo Avogadro, Novara.
Pizzorno
Chiara
C
Pessione
Silvia
S
Bellora
Paolo
P
Garavaglia
Marcello
M
D001013:Aorta, Thoracic / Q000293:injuries; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery; D001018:Aortic Diseases / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002637:Chest Pain / Q000209:etiology; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D004937:Esophageal Fistula / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D017809:Fatal Outcome; D005402:Fistula / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D019919:Prosthesis Implantation; D012772:Shock, Septic / Q000209:etiology; D014057:Tomography, X-Ray Computed