title: [Successful management of aorto-esophageal fistula, using staged 3 times operation].
abstract: A 66-year-old man, presented with hematemesis and hemorrhagic shock, was transported to our institution. Computed tomographic examination suggested a pseudo-aneurysm formed by bleeding from aorto-esophageal fistula( AEF). We planned staged operations. At first, in an emergent operation, graft replacement of descending aorta, was performed under partial cardiopulmonary bypass, by left thoracotomy approach. AEF was 5 mm in diameter, and existed inside of normal-diameter and non-aneurysmal aortic intima. AEF orifice into pseudo-aneurysm was closed with aortic wall and was sutured tightly. Next day, gastrointestinal fiberscopy was performed, and penetrating ulcer was found at lower esophagus.To prevent infective complications, the 2nd operation, subtotal esophagectomy, cervical esophagostomy, gastrostomy and tube ileostomy were performed by right thoracotomy approach. Post- operative course was uneventful. Two months later, 3rd operation, cervical esophago-gastric anastomosis was performed, uneventfully. Two years and four months elapsed, and no evidences of infection and formation of pseudo-aneurysm were observed.
authors.affiliation: Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Nomura
authors.forename: Naoki
authors.initials: N
authors.lastname: Masaki
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Sato
authors.forename: Satoru
authors.initials: S
authors.lastname: Arai
authors.forename: Manabu
authors.initials: M
authors.lastname: Fukasawa
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery; D004937:Esophageal Fistula / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016157:Vascular Fistula / Q000150:complications / Q000601:surgery*