title: Life-threatening bleeding from arterial-oesophageal fistula following oesophagectomy.
abstract: Oesophageal carcinoma remains one of the most common forms of cancer. Resection in the form of oesophagectomy and gastric interposition remains the standard surgical treatment and is associated with a high rate of post-operative morbidity. We report a case of a 71-year old male who underwent successful Ivor-Lewis oesophageal resection and developed life-threatening haemorrhage 2 weeks post-op, attributed to an arterial-oesophageal fistula. The patient was transferred to a specialist ENT centre with ligation of branches of the carotid artery, but intermittent bleeding continued. Following transfer to a specialist oesophago-gastric unit, repeated angiography was required to image the point of bleeding, which was embolised via percutaneous technique. The etiology, presentation, diagnosis and management of arterial-oesophageal fistulae are discussed, along with review of existing reports of similar complications and treatment options. A multidisciplinary approach, along with timely and often repeated imaging, is required in the management of arterial-oesophageal fistulae.
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, London, UK. p.pucher@imperial.ac.uk
authors.forename: Philip
authors.initials: P
authors.lastname: Pucher
authors.forename: Elika
authors.initials: E
authors.lastname: Kashef
authors.forename: Caroline
authors.initials: C
authors.lastname: Woods
authors.forename: Jeremy
authors.initials: J
authors.lastname: Livingstone
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002340:Carotid Artery Diseases / Q000209:etiology*; D004630:Emergencies; D004937:Esophageal Fistula / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D016157:Vascular Fistula / Q000209:etiology*