title: Aortic fistula after neoadjuvant chemoradiotherapy and esophagectomy for esophageal carcinoma: an unusual cause of sudden death.
abstract: Aortic fistula to the enteric tract is an uncommon but recognized complication of esophagectomy, whereas an aortorespiratory fistula is usually described in the setting of aortic disease or previous aortic surgery. We describe 2 cases of fatal aortic fistula occurring after esophagectomy and neoadjuvant chemoradiotherapy, both encountered at autopsy.The first case is an aortobronchial fistula occurring in a 47-year-old male in the early postoperative setting. Death was caused by rupture of the fistula into the posterior mediastinum with transhiatal extension and hemoperitoneum. The tissue adjacent to the fistula showed radiation effect, and an esophageal stent had been placed before surgery. The second case is an aortogastric tube fistula occurring in a 50-year-old male 2 years after surgery and resulting in fatal gastrointestinal hemorrhage. The fistula involved the site of anastomosis and a surgical clip was present in the adjacent soft tissue.The development of aortic fistula after esophagectomy for esophageal carcinoma is rare, but should be considered at autopsy as a potential cause of unexpected, sudden death in these patients. Possible inciting mechanisms in this setting include the presence of foreign material (stent placement and surgical clips) and previous chemoradiation.
authors.affiliation: Department of Histopathology, University Hospital Galway, Newcastle Road, Galway, Ireland. caoimheegan@gmail.com
authors.forename: Caoimhe
authors.initials: C
authors.lastname: Egan
authors.forename: Peter
authors.initials: P
authors.lastname: Szontagh-Kishazi
authors.forename: Richard
authors.initials: R
authors.lastname: Flavin
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy; D001013:Aorta, Thoracic / Q000473:pathology; D001018:Aortic Diseases / Q000209:etiology*; D001983:Bronchial Fistula / Q000209:etiology; D059186:Chemoradiotherapy, Adjuvant; D003645:Death, Sudden / Q000209:etiology*; D004750:Enteral Nutrition / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects*; D049429:Forensic Pathology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016157:Vascular Fistula / Q000209:etiology*