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Survival following Treatment of Aortoesophageal Fistula with Dual Esophageal and Aortic Intervention.

Ghosh SK, Rahman FZ, Bown S, Harris P, Fong K, Langmead L - Case Rep Gastroenterol (2011)

Bottom Line: Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult.CT angiography confirmed an aortoesophageal fistula.He survived for 2 months at home before dying of disseminated malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University College Hospital, London, UK.

ABSTRACT
Aortoesophageal fistulas are a rare but commonly fatal complication of esophageal cancer. Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult. We report the case of a 47-year-old Caucasian man with recently diagnosed advanced esophageal cancer who suffered an episode of massive haematemesis. Emergency gastroscopy revealed an arterial bleeding point in the proximal esophagus. A self-expanding metal esophageal stent was placed to achieve initial partial haemostasis. CT angiography confirmed an aortoesophageal fistula. An endoluminal stent device was thus inserted within the thoracic aorta stabilising the bleeding point. The patient subsequently made an uneventful recovery and was discharged on long-term antibiotics for palliative care. He survived for 2 months at home before dying of disseminated malignancy. The successful use of esophageal stenting as a means of achieving haemostasis, allowing time for endovascular intervention, is as yet a relatively unexplored area of management of this rare condition.

No MeSH data available.


Related in: MedlinePlus

CT angiography images. a An aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum. The esophagus is filled with old clot without contrast, indicating successful tamponade of the fistula. b An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis.
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Figure 3: CT angiography images. a An aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum. The esophagus is filled with old clot without contrast, indicating successful tamponade of the fistula. b An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis.

Mentions: CT angiography was performed and demonstrated an aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum (fig. 3a). An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis (fig. 3b). The patient was discharged on long-term antibiotics for palliative care. He survived for 2 months at home, during which he was able to attend to his personal affairs, before dying of disseminated malignancy.


Survival following Treatment of Aortoesophageal Fistula with Dual Esophageal and Aortic Intervention.

Ghosh SK, Rahman FZ, Bown S, Harris P, Fong K, Langmead L - Case Rep Gastroenterol (2011)

CT angiography images. a An aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum. The esophagus is filled with old clot without contrast, indicating successful tamponade of the fistula. b An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3037993&req=5

Figure 3: CT angiography images. a An aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum. The esophagus is filled with old clot without contrast, indicating successful tamponade of the fistula. b An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis.
Mentions: CT angiography was performed and demonstrated an aortoesophageal fistula at the level of the carina with ongoing bleeding into the mediastinum (fig. 3a). An endoluminal vascular stent (COOK TX2 36 mm × 120) was inserted into the thoracic aorta distal to the origin of the left subclavian artery sealing the fistula. Repeat CT angiography confirmed haemostasis (fig. 3b). The patient was discharged on long-term antibiotics for palliative care. He survived for 2 months at home, during which he was able to attend to his personal affairs, before dying of disseminated malignancy.

Bottom Line: Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult.CT angiography confirmed an aortoesophageal fistula.He survived for 2 months at home before dying of disseminated malignancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, University College Hospital, London, UK.

ABSTRACT
Aortoesophageal fistulas are a rare but commonly fatal complication of esophageal cancer. Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult. We report the case of a 47-year-old Caucasian man with recently diagnosed advanced esophageal cancer who suffered an episode of massive haematemesis. Emergency gastroscopy revealed an arterial bleeding point in the proximal esophagus. A self-expanding metal esophageal stent was placed to achieve initial partial haemostasis. CT angiography confirmed an aortoesophageal fistula. An endoluminal stent device was thus inserted within the thoracic aorta stabilising the bleeding point. The patient subsequently made an uneventful recovery and was discharged on long-term antibiotics for palliative care. He survived for 2 months at home before dying of disseminated malignancy. The successful use of esophageal stenting as a means of achieving haemostasis, allowing time for endovascular intervention, is as yet a relatively unexplored area of management of this rare condition.

No MeSH data available.


Related in: MedlinePlus