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Conservative treatment of an aortoesophagial fistula after endovascular stent grafting for a thoracic aortic aneurysm.

Kasai K, Ushio A, Tamura Y, Sawara K, Kasai Y, Oikawa K, Endo M, Takikawa Y, Suzuki K - Med. Sci. Monit. (2011)

Bottom Line: Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics.Afterwards, no signs of hemorrhage were observed.Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan. kaz-k@yc4.so-net.ne.jp

ABSTRACT

Background: Aortoesophageal fistula (AEF) is an uncommon condition that presents a problem in therapy because of the high rate of morbidity and mortality associated with its surgical management and the uniformly fatal outcome of medical treatment. In this article we describe a case of secondary AEF after endoluminal stent grafting of the thoracic aorta, which was observed by only conservative management and followed up for 14 months with no signs of recurrent hemorrhage or chronic mediastinitis.

Case report: A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He had a history of traumatic aneurysm, and undergone segmental replacement with a stent graft three years ago. After admission, Esophagogastroduodenoscopy and computed tomography identified AEF. He was treated conservatively, because his stage of HCC was advanced. Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics. Afterwards, no signs of hemorrhage were observed. Although oral intake was resumed after that, another bleeding event or development of mediastinitis was not observed. Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC.

Conclusions: Although we observed 14 months survival in our case under conservative management of secondary AEF, it seems that the treatment of secondary AEF should do the operative management.

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Related in: MedlinePlus

Computed tomography done 1 month after endovascular stent grafting. There was no endoleak.
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f1-medscimonit-17-4-cs39: Computed tomography done 1 month after endovascular stent grafting. There was no endoleak.

Mentions: A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He presented with back pain, fever and elevated laboratory markers of systemic inflammation. He had a history of traumatic aneurysm of the descending thoracic aorta three years ago. He had undergone post segmental replacement with a stent graft which was constructed by sewing a Dacron graft to a Gianturco-Rosch Z stent (Figure 1). On admission, there was no sign of active bleeding and he was hemodynamically stable. After admission, Esophagogastroduodenoscopy (EGD) was performed. EGD identified esophageal ulcer with evidence of slight ongoing bleeding at 20 cm beyond the dental arch (Figure 2). A subsequent enhanced computed tomography (CT) showed soft tissue density mass and air bubbles inside which suggested an AEF around descending thoracic stent graft (Figure 3). Surgical repair was not undertaken, because his stage of HCC was advanced, and his long-term prognosis was not expectable. He was treated conservatively. Oral intake was prohibited, and the patient received proton pump inhibitors (PPI), intravenous hyperalimentation and antibiotics (sulbactam/cefoperazone (SBT/CPZ)). SBT/CPZ was administered for 4 weeks. PPI was administered for 2 months. During follow up period, no signs of bleeding and mediastinitis were observed.


Conservative treatment of an aortoesophagial fistula after endovascular stent grafting for a thoracic aortic aneurysm.

Kasai K, Ushio A, Tamura Y, Sawara K, Kasai Y, Oikawa K, Endo M, Takikawa Y, Suzuki K - Med. Sci. Monit. (2011)

Computed tomography done 1 month after endovascular stent grafting. There was no endoleak.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539520&req=5

f1-medscimonit-17-4-cs39: Computed tomography done 1 month after endovascular stent grafting. There was no endoleak.
Mentions: A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He presented with back pain, fever and elevated laboratory markers of systemic inflammation. He had a history of traumatic aneurysm of the descending thoracic aorta three years ago. He had undergone post segmental replacement with a stent graft which was constructed by sewing a Dacron graft to a Gianturco-Rosch Z stent (Figure 1). On admission, there was no sign of active bleeding and he was hemodynamically stable. After admission, Esophagogastroduodenoscopy (EGD) was performed. EGD identified esophageal ulcer with evidence of slight ongoing bleeding at 20 cm beyond the dental arch (Figure 2). A subsequent enhanced computed tomography (CT) showed soft tissue density mass and air bubbles inside which suggested an AEF around descending thoracic stent graft (Figure 3). Surgical repair was not undertaken, because his stage of HCC was advanced, and his long-term prognosis was not expectable. He was treated conservatively. Oral intake was prohibited, and the patient received proton pump inhibitors (PPI), intravenous hyperalimentation and antibiotics (sulbactam/cefoperazone (SBT/CPZ)). SBT/CPZ was administered for 4 weeks. PPI was administered for 2 months. During follow up period, no signs of bleeding and mediastinitis were observed.

Bottom Line: Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics.Afterwards, no signs of hemorrhage were observed.Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan. kaz-k@yc4.so-net.ne.jp

ABSTRACT

Background: Aortoesophageal fistula (AEF) is an uncommon condition that presents a problem in therapy because of the high rate of morbidity and mortality associated with its surgical management and the uniformly fatal outcome of medical treatment. In this article we describe a case of secondary AEF after endoluminal stent grafting of the thoracic aorta, which was observed by only conservative management and followed up for 14 months with no signs of recurrent hemorrhage or chronic mediastinitis.

Case report: A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He had a history of traumatic aneurysm, and undergone segmental replacement with a stent graft three years ago. After admission, Esophagogastroduodenoscopy and computed tomography identified AEF. He was treated conservatively, because his stage of HCC was advanced. Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics. Afterwards, no signs of hemorrhage were observed. Although oral intake was resumed after that, another bleeding event or development of mediastinitis was not observed. Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC.

Conclusions: Although we observed 14 months survival in our case under conservative management of secondary AEF, it seems that the treatment of secondary AEF should do the operative management.

Show MeSH
Related in: MedlinePlus