title: Conservative treatment of an aortoesophagial fistula after endovascular stent grafting for a thoracic aortic aneurysm.
abstract: BACKGROUND
  Aortoesophageal fistula (AEF) is an uncommon condition that presents a problem in therapy because of the high rate of morbidity and mortality associated with its surgical management and the uniformly fatal outcome of medical treatment. In this article we describe a case of secondary AEF after endoluminal stent grafting of the thoracic aorta, which was observed by only conservative management and followed up for 14 months with no signs of recurrent hemorrhage or chronic mediastinitis.
  
  
  METHODS
  A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He had a history of traumatic aneurysm, and undergone segmental replacement with a stent graft three years ago. After admission, Esophagogastroduodenoscopy and computed tomography identified AEF. He was treated conservatively, because his stage of HCC was advanced. Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics. Afterwards, no signs of hemorrhage were observed. Although oral intake was resumed after that, another bleeding event or development of mediastinitis was not observed. Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC.
  
  
  CONCLUSIONS
  Although we observed 14 months survival in our case under conservative management of secondary AEF, it seems that the treatment of secondary AEF should do the operative management.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan. kaz-k@yc4.so-net.ne.jp
authors: Kazuhiro
authors: K
authors: Kasai
authors: Akira
authors: A
authors: Ushio
authors: Yoko
authors: Y
authors: Tamura
authors: Kei
authors: K
authors: Sawara
authors: Yukiho
authors: Y
authors: Kasai
authors: Kanta
authors: K
authors: Oikawa
authors: Masaki
authors: M
authors: Endo
authors: Yasuhiro
authors: Y
authors: Takikawa
authors: Kazuyuki
authors: K
authors: Suzuki
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed