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Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed

INTRODUCTION: Aorto-oesophageal fistula is a rare but life threatening cause of upper gastrointestinal haemorrhage. Severity of presentation and complexity of subsequent management depends on the size of the defect on both the aortic side and oesophagus. REPORT: The patient was a 67 year old Chinese...

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Autores principales: Majumder, Arunesh, Dharmaraj, Rajesh B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033050/
https://www.ncbi.nlm.nih.gov/pubmed/29988842
http://dx.doi.org/10.1016/j.ejvssr.2018.04.003
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author Majumder, Arunesh
Dharmaraj, Rajesh B.
author_facet Majumder, Arunesh
Dharmaraj, Rajesh B.
author_sort Majumder, Arunesh
collection PubMed
description INTRODUCTION: Aorto-oesophageal fistula is a rare but life threatening cause of upper gastrointestinal haemorrhage. Severity of presentation and complexity of subsequent management depends on the size of the defect on both the aortic side and oesophagus. REPORT: The patient was a 67 year old Chinese man, who presented initially with a Stanford type A dissection with caudal extension to the right common iliac artery. The patient underwent replacement of the ascending aorta and proximal arch with debranching of the right innominate artery and aortic valve replacement. A follow up computed tomography (CT) aortogram done in the post-operative period showed a stable appearance of the caudal extension of the aortic dissection. The patient was discharged with a plan for future stenting of the thoracic aorta. Three weeks later the patient re-presented with an upper gastrointestinal bleed from an aorto-oesophageal fistula. The patient underwent endovascular stenting of the descending aorta for management of the fistula. Repeat oesophagogastroduodenoscopy showed a small erosion 35 cm from the incisors where the previous bleeding site had been. No further bleeding was seen. DISCUSSION: The patient recovered uneventfully after the procedure. Follow up CT aortogram done at 6 weeks demonstrated thrombosis of the false lumen of the descending thoracic aorta. Aorto-oesophageal fistula related to chronic type B aortic dissection is an extremely rare clinical entity and presents a challenge to the treating surgeon. This case demonstrates that selected cases can be judiciously managed by thoracic endovascular aneurysm repair alone.
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spelling pubmed-60330502018-07-09 Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed Majumder, Arunesh Dharmaraj, Rajesh B. EJVES Short Rep Case Report INTRODUCTION: Aorto-oesophageal fistula is a rare but life threatening cause of upper gastrointestinal haemorrhage. Severity of presentation and complexity of subsequent management depends on the size of the defect on both the aortic side and oesophagus. REPORT: The patient was a 67 year old Chinese man, who presented initially with a Stanford type A dissection with caudal extension to the right common iliac artery. The patient underwent replacement of the ascending aorta and proximal arch with debranching of the right innominate artery and aortic valve replacement. A follow up computed tomography (CT) aortogram done in the post-operative period showed a stable appearance of the caudal extension of the aortic dissection. The patient was discharged with a plan for future stenting of the thoracic aorta. Three weeks later the patient re-presented with an upper gastrointestinal bleed from an aorto-oesophageal fistula. The patient underwent endovascular stenting of the descending aorta for management of the fistula. Repeat oesophagogastroduodenoscopy showed a small erosion 35 cm from the incisors where the previous bleeding site had been. No further bleeding was seen. DISCUSSION: The patient recovered uneventfully after the procedure. Follow up CT aortogram done at 6 weeks demonstrated thrombosis of the false lumen of the descending thoracic aorta. Aorto-oesophageal fistula related to chronic type B aortic dissection is an extremely rare clinical entity and presents a challenge to the treating surgeon. This case demonstrates that selected cases can be judiciously managed by thoracic endovascular aneurysm repair alone. Elsevier 2018-05-03 /pmc/articles/PMC6033050/ /pubmed/29988842 http://dx.doi.org/10.1016/j.ejvssr.2018.04.003 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Majumder, Arunesh
Dharmaraj, Rajesh B.
Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title_full Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title_fullStr Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title_full_unstemmed Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title_short Successful Endovascular Management of a Case of Aorto-oesophageal Fistula Presenting as Life Threatening Upper Gastrointestinal Bleed
title_sort successful endovascular management of a case of aorto-oesophageal fistula presenting as life threatening upper gastrointestinal bleed
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033050/
https://www.ncbi.nlm.nih.gov/pubmed/29988842
http://dx.doi.org/10.1016/j.ejvssr.2018.04.003
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