title: Atrio-esophageal fistula complicating esophageal achalasia.
abstract: A 75-year-old male, known to have achalasia, was admitted to the intensive care unit with massive upper gastrointestinal bleeding and sepsis. He had a history of purulent pericarditis 18 months earlier. He also presented with atrial fibrillation associated with a cerebral transient ischemic accident two months earlier. A contrast computed tomography scan showed an atrio-esophageal fistula with active extravasation of contrast. He was operated on via a median sternotomy, and the defects in the atrial wall, inferior vena cava and diaphragm were closed using pericardial patches. An esophagectomy was to be performed 24 hours later, but the patient died from septic shock and multiple organ failure before his second procedure.
authors.affiliation: Department of Cardiovascular Surgery, Assistance publique des Hôpitaux de Paris, Paris, France. paul.achouh@egp.aphp.fr
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.forename: Julia
authors.initials: J
authors.lastname: Pouly
authors.forename: Arshid
authors.initials: A
authors.lastname: Azarine
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003937:Diagnosis, Differential; D004931:Esophageal Achalasia / Q000150:complications* / Q000601:surgery; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D017809:Fatal Outcome; D005402:Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed