Radiation therapy-induced aortoesophageal fistula: a case report and review of literature (original) (raw)
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Case Reports in Gastroenterology, 2008
Primary aorto-duodenal fistula (PADF) is a rare condition that may result in rapid exsanguination if untreated. PADF due to radiotherapy appears to be extremely rare with only a few cases reported in the medical literature. We report the case of a 61-year-old man who presented with massive gastrointestinal bleeding 25 years after surgery and radiotherapy for seminoma of the testicle and was successfully treated at our institution. We also review the literature on this very uncommon condition. A Medline search was conducted for the period from 1966 to June 2006 to identify case reports of PADF following radiotherapy. Only 7 cases of PADF due to radiotherapy were identified in addition to our own, 4 males and 3 females, aged 40 to 73 years, all treated for various forms of abdominal malignancies. The latency period ranged from 2 weeks to 25 years. None of the aortas were aneurysmatic. One patient died before he could be taken to the operating room. 5 patients underwent surgical repair and 4 survived. 2 patients underwent endovascular treatment but did not survive. PADF may develop up to 25 years after radiotherapy. Diagnosis should be considered when massive upper gastrointestinal bleeding develops in a patient who had previous abdominal radiotherapy, no matter how long before the episode of bleeding. Prompt surgical repair offers a reasonable chance of cure. Endovascular procedures do not appear to be efficacious.
Internal Medicine, 2020
A 63-year-old man had received chemoradiotherapy 7 years ago for stage IIIA pulmonary adenocarcinoma of the left lower lobe and stereotactic irradiation 3 years ago for stage IA pulmonary squamous cell carcinoma of the left upper lobe. An esophageal stent was placed because of esophageal narrowing caused by tumor invasion. Five months later, he was diagnosed with an aortoesophageal fistula. Because invasive surgery posed challenges, thoracic endovascular aortic repair (TEVAR) was performed. We report this rare case of aortoesophageal fistula treated using TEVAR. However, the therapeutic effect was temporary. Further studies investigating the indications for TEVAR are warranted.
Aortoesophageal fistula: A case report
Case report international, 2022
Introduction: Aortoesophageal fistula (AEF) is a rare and potentially lethal cause of upper gastrointestinal bleeding. Although several causes have been implicated in this condition, a ruptured thoracic aortic aneurysm remains the most common cause. Despite the challenge of differential diagnosis, this is a situation that requires prompt action with immediate hemorrhage control. Case Report: We report a case of a 56-year-old woman who presented with hemorrhagic shock secondary to AEF with no underlying cause identified, treated with Thoracic Endovascular Aortic Repair (TEVAR) after immediate bleeding control with a Sengstaken-Blakemore (SB) tube. Post-operatively the patient developed pneumonia and operative wound infection that were treated conservatively. At 24 months follow-up, the patient is asymptomatic and there is no clinical, analytical, or imagiological evidence of vascular graft infection. Conclusion: Survival outcomes have improved with the advent of endoluminal aortic stent therapies and TEVAR is currently considered a viable approach for AEF bleeding control in the emergency setting for unstable patients. However, long-term concerns remain since TEVAR is not a definitive treatment for AEF defect, leaving the patients at risk for AEF recurrence but also for stent graft infection. Resection of the esophagus with restoration of gastrointestinal continuity and vascular reconstruction can be performed in a one or two stage procedure and is the definitive treatment for AEF.
Aortoesophageal Fistula Occurring Due to Aortic Aneurysm
Cureus
Upper gastrointestinal bleeding is a rare presentation of the aortoesophageal fistula (AEF) and is usually caused by thoracic aortic aneurysms. We present the case of a 61-year-old male who presented with chest pain and hematemesis. A chest X-ray showed a widened mediastinum. The patient underwent computed tomography angiography (CTA), which showed the presence of a large aneurysm in the aorta, which caused compression of the trachea, esophagus, and left pulmonary artery. Additionally, there was evidence of an AEF. It was decided to perform an emergency surgical intervention on the patient. However, the patient had multiple episodes of hematemesis and expired.
Aortoesophageal fistula in a patient with carcinoma of the esophagus – Case report
Angiologia e Cirurgia Vascular, 2016
Primary aortoesophgeal fistulas (AEF) are a rare but life-threatening condition because of substantial hemorrhage, requiring fast treatment to ensure patient survival. We report a case of a 69-year-old male with diagnosis of squamous cell carcinoma of the esophagus who suffered an episode of hematemesis and hemorrhagic shock. Gastrointestinal (GI) endoscopy revealed an ulcerated lesion with pulsatile hemorrhage. CT-scan confirmed the diagnosis of AEF. A stent-graft was placed in the descending aorta to control bleeding, and 2 days later an esophageal stent was deployed to reduce risk of aortic graft infection. The patient was discharged 13 days after admission and had no other episode of GI bleeding in a 6-month follow-up period. TEVAR may be used as a palliative or bridge treatment of AEF.
Esophageal pulmonary fistula – a rare complication of radiation therapy: a case report
Journal of Medical Case Reports, 2018
Background: Esophageal respiratory fistulae are abnormal communications between the esophagus and the respiratory system. They are either congenital or acquired. Most acquired esophageal respiratory fistulae are of the esophageal tracheal and esophageal bronchial type and are caused by infections or malignant neoplasms, whereas esophageal pulmonary fistulae are rare. Case presentation: We report a case of a 72-year-old Caucasian man with squamous cell carcinoma of the lung presenting with abrupt-onset dyspnea during localized mediastinal radiotherapy. His laboratory test results suggested major respiratory infection. A chest x-ray revealed left apical lung radiopacity along with excavated lesions, consistent with secondary tumor infection. No clinical improvement was observed despite antibiotic treatment. A contrastenhanced computed tomographic scan of the chest confirmed persistent lung infection with unfavorable progression and air in the mediastinum; the latter suggested a fistula from the upper third of the esophagus to the upper left pulmonary lobe. Videofluoroscopy confirmed the diagnosis of an acquired esophageal pulmonary fistula. The patient underwent endoscopy, and an esophageal self-expandable metallic stent was deployed. Conclusions: Esophageal pulmonary fistulae must be suspected whenever patients undergoing local mediastinal radiotherapy present with acute pulmonary complications, particularly pneumonia resistant to antibiotic treatment. Esophageal pulmonary fistulae are diagnosed by means of radiological imaging. Because esophageal respiratory fistulae are acute life-threatening conditions, prompt treatment with an endoscopically placed covered stent proves vital.
Primary Aortoesophageal Fistula due to Thoracic Aortic Aneurysm: Successful Surgical Treatment
Texas Heart Institute Journal from the Texas Heart Institute of St Luke S Episcopal Hospital Texas Children S Hospital, 2009
Aortoesophageal fistula is a rare emergency that presents a real challenge for cardiothoracic surgeons. There have been few reports of survivors. We present the case of a 70-year-old man with aortoesophageal fistula, mediastinal abscess, and severe septicemia consequent to esophageal erosion and rupture of a chronic degenerative descending thoracic aortic aneurysm. The patient underwent successful surgical treatment by aortoaortic bypass and bipolar esophageal exclusion in conjunction with a cervical esophagostomy and a feeding gastrostomy. The pleural cavity was copiously irrigated and drained. Three months later, a retrosternal gastric bypass operation was performed successfully. The patient's 6-month follow-up examination revealed no problems. (Tex Heart Inst J 2009;36(6):607-10) A ortoesophageal fistula (AEF) is a rare cause of gastrointestinal bleeding. Surgery is crucial for survival. It is of great importance that both the thoracic aortic aneurysm and the esophageal erosion be treated in order to avoid massive hemorrhage and septic sequelae. 1,2
The Heart Surgery Forum, 2011
Purpose: We present the case of a patient who developed an aortoesophageal fi stula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture. Case Report: A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery. Conclusion: AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.