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Sentinel bleeding as a sign of gastroaortic fistula formation after oesophageal surgery.

Uittenbogaart M, Sosef MN, van Bastelaar J - Case Rep Surg (2014)

Bottom Line: Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula.The sudden onset of haemorrhage makes this condition particularly difficult to treat.Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.

ABSTRACT
Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

No MeSH data available.


Related in: MedlinePlus

Images of radiation field showing embedding of the anterior wall of the descending aorta and of the oesophagus.
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fig1: Images of radiation field showing embedding of the anterior wall of the descending aorta and of the oesophagus.

Mentions: The contribution of neoadjuvant therapy to the formation of fistula is to be considered. Our patient was treated with a five-week course of carboplatin/paclitaxel combined with radiation therapy consisting of 23 fractions of 1.8 Gy (total 41.4 Gy). As shown in Figure 1, along with the oesophagus, the anterior wall of the descending aorta is embedded in the radiation field. It is possible that radiation caused relative ischemia of the oesophagus causing partial destruction of the mucosal barrier. Histological studies have shown that mainly the submucosal layer is affected by the radiation, resulting in teleangiectasia, fibrosis, and neovascularization [8]. Besides causing damage to the epithelium of the intestinal tract, damage to the arterial wall could be expected following radiotherapy. Previous reports have shown the possibility of aortic rupture due to subclinical perivascular infection following radiation therapy [9].


Sentinel bleeding as a sign of gastroaortic fistula formation after oesophageal surgery.

Uittenbogaart M, Sosef MN, van Bastelaar J - Case Rep Surg (2014)

Images of radiation field showing embedding of the anterior wall of the descending aorta and of the oesophagus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269212&req=5

fig1: Images of radiation field showing embedding of the anterior wall of the descending aorta and of the oesophagus.
Mentions: The contribution of neoadjuvant therapy to the formation of fistula is to be considered. Our patient was treated with a five-week course of carboplatin/paclitaxel combined with radiation therapy consisting of 23 fractions of 1.8 Gy (total 41.4 Gy). As shown in Figure 1, along with the oesophagus, the anterior wall of the descending aorta is embedded in the radiation field. It is possible that radiation caused relative ischemia of the oesophagus causing partial destruction of the mucosal barrier. Histological studies have shown that mainly the submucosal layer is affected by the radiation, resulting in teleangiectasia, fibrosis, and neovascularization [8]. Besides causing damage to the epithelium of the intestinal tract, damage to the arterial wall could be expected following radiotherapy. Previous reports have shown the possibility of aortic rupture due to subclinical perivascular infection following radiation therapy [9].

Bottom Line: Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula.The sudden onset of haemorrhage makes this condition particularly difficult to treat.Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.

ABSTRACT
Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

No MeSH data available.


Related in: MedlinePlus