Radiation therapy-induced aortoesophageal fistula: a case report and review of literature.
Aortoesophageal fistula (AEF) is a rare cause of massive upper gastrointestinal hemorrhage. Thoracic aortic aneurysm, esophageal foreign body, esophageal cancer and post-surgical complications are common causes of AEF; however, AEF induced by radiation therapy is a rare phenomenon and seldom described in the literature. It is a catastrophic condition which requires rapid implementation of resuscitative measures, broad-spectrum antibiotics and surgical or endovascular intervention. Transthoracic endovascular aortic repair (TEVAR) is a newer and less invasive technique, which helps to achieve rapid hemostasis in patients with severe hemodynamic instability and offers advantages over conventional repair of the aorta in emergency situations. However initial TEVAR should be followed up with a more definitive surgical repair of the aorta and the esophagus, to lower the mortality rate and achieve better outcomes. We describe here a case of a seventy-year-old male who presented with massive upper gastrointestinal bleeding due to AEF induced by radiation therapy, and his subsequent successful initial management with TEVAR.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Presence Saint Francis Hospital, Evanston, Illinois, USA malavparikh88@yaho.com.
Malav P
MP
Parikh
Department of Gastroenterology and Hepatology, Georgia Regents University, Augusta, Georgia, USA.
Muhammed
M
Sherid
Department of Internal Medicine, Government Medical College Calicut, Kerala, India.
Sreelakshmi
S
Panginikkod
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Presence Saint Francis Hospital, Evanston, Illinois, USA.
Harsh A
HA
Rawal
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Presence Saint Francis Hospital, Evanston, Illinois, USA.
Venu
V
Gopalakrishnan
aortoesophageal fistula; gastrointestinal hemorrhage; radiation therapy; transthoracic endovascular aortic repair