Aortoesophageal fistula due to esophageal cancer: a case report of successful management

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2024年4月17日

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Kohei Saisho,
Naoki Mori,
Masashi Nakagawa,
Eiji Nakamura,
Yu Tanaka,
Hideaki Kaku,
Yuya Tanaka,
Taro Isobe,
Hiroyuki Otsuka,
Tomoya Sudo,
Hisamune Sakai,
Nobuya Ishibashi,
Toru Hisaka,
Eiki Tayama,
Fumihiko Fujita

摘要

Background

Aortoesophageal fistula (AEF) is a rare but potentially life-threatening condition. The best treatment for the AEF due to esophageal carcinoma is still unresolved. Here, we report a rare case of AEF caused by esophageal cancer, that was successfully treated with emergency thoracic endovascular aortic repair (TEVAR), followed by esophagectomy and gastric tube reconstruction.

Case presentation

A 64-year-old man presented with loss of consciousness and hypotension during chemoradiotherapy for advanced esophageal cancer. Enhanced computed tomography showed extravasation from the descending aorta into the esophagus at the tumor site. We performed emergency TEVAR for the AEF, which stabilized the hemodynamics. We then performed thoracoscopic subtotal esophagectomy on day 4 after TEVAR to prevent graft infection, followed by gastric tube reconstruction on day 30 after TEVAR. At 9 months after the onset of AEF, the patient continues to receive outpatient chemotherapy and leads a normal daily life.

Conclusion

TEVAR is a useful hemostatic procedure for AEF. If the patient is in good condition and can continue treatment for esophageal cancer, esophagectomy and reconstruction after TEVAR should be performed to prevent graft infection and maintain quality of life.