J Korean Med Sci.  2015 Nov;30(11):1706-1709. 10.3346/jkms.2015.30.11.1706.

Two-stage Surgery for an Aortoesophageal Fistula Caused by Tuberculous Esophagitis

• Shin HK
• Choi CW
• Lim JW
• Her K

• KMID: 2351125
• DOI: http://doi.org/10.3346/jkms.2015.30.11.1706

Abstract

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.

Keyword

Esophageal Fistula; Aortic Disease; Thoracic Endovascular Aortic Repair (TEVAR)

MeSH Terms

Aortic Diseases/etiology/*surgery
Eosinophilic Esophagitis/*complications/*surgery
Esophageal Fistula/etiology/*surgery
Esophagoscopy/*methods
Humans
Male
Middle Aged
Treatment Outcome
Tuberculosis/*complications/surgery
Vascular Surgical Procedures/methods

Figure

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  Fig. 1 A swelling was seen on the outer wall of the esophagus, through which blood leaked directly from the aorta.

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  Fig. 2 After thoracic endovascular aortic repair (TEVAR). (A) Esophagogastroduodenoscopy (EGD) showing esophageal swelling. (B) Before TEVAR aortography. (C) After TEVAR aortography, no blood leakage was visible.

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  Fig. 3 Esophageal anastomotic leakage. (A) Esophageal anastomotic leakage was observed on esophagography. (B) Esophagogastroduodenoscopy (EGD) was performed to confirm the site of the leakage. (C) After the anastomotic leak site was closed, no further leakage was visible on esophagography.

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