title: Management options for aorto-oesophageal fistula: case histories and review of the literature.
abstract: OBJECTIVE
  An aorto-oesophageal fistula is a rare clinical entity, leading to life-threatening gastrointestinal bleeding. Thoracic aortic aneurysms are the most common cause of aorto-oesophageal fistulae; further causes involve foreign body ingestion, trauma (in most cases iatrogenic), carcinoma or, very rarely, aortitis tuberculotica.
  
  
  METHODS
  Due to its rarity, there are no large multicentre studies present to evaluate the efficacy of different therapeutic management options. Since it is associated with significant morbidity and mortality, we give a short summary of various treatment approaches performed in our clinical practice in the past three years. The most straightforward therapeutic option may be an endovascular aortic repair and subtotal oesophageal resection followed by gastro-oesophageal reconstruction, but other alternative treatment possibilities are also present, although with probable higher morbidity.
  
  
  CONCLUSIONS
  Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach.
authors: Department Cardiothoracic Surgery, Southampton General Hospital, Southampton University Hospital Trust, Southampton, UK. isartor@hotmail.com
authors: L
authors: L
authors: Göbölös
authors: S
authors: S
authors: Miskolczi
authors: D
authors: D
authors: Pousios
authors: G M
authors: GM
authors: Tsang
authors: S A
authors: SA
authors: Livesey
authors: C W
authors: CW
authors: Barlow
authors: M
authors: M
authors: Kaarne
authors: J
authors: J
authors: Shambrook
authors: A
authors: A
authors: Lipnevicius
authors: S K
authors: SK
authors: Ohri
mesh_terms: D001011:Aorta / Q000473:pathology / Q000601:surgery; D001018:Aortic Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D004937:Esophageal Fistula / Q000150:complications / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D016157:Vascular Fistula / Q000150:complications / Q000473:pathology* / Q000601:surgery / Q000628:therapy*
keywords: aorto-oesophageal fistula; conservative management; endovascular aortic repair; gastro-oesophageal reconstruction; surgical approach