Case Report

Esophagus

, Volume 8, Issue 4, pp 277-281

First online:

Intractable esophago-mediastinal fistula as a rare complication following thoracoabdominal aortic replacement

  • Takeyuki WadaAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Hiroya TakeuchiAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University Email author 
  • , Naoki FujimuraAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Rieko NakamuraAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Takashi OyamaAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Tsunehiro TakahashiAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Norihito WadaAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Yoshiro SaikawaAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University
  • , Hideyuki ShimizuAffiliated withDivision of Cardiovascular Surgery, Department of Surgery, School of Medicine, Keio University
    • , Ryohei YozuAffiliated withDivision of Cardiovascular Surgery, Department of Surgery, School of Medicine, Keio University
    • , Yuko KitagawaAffiliated withDivision of General and Gastrointestinal Surgery, Department of Surgery, School of Medicine, Keio University

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Abstract

Although occurring infrequently, esophago-mediastinal fistula is potentially life-threatening. We report a rare case of intractable esophago-mediastinal fistula following thoracoabdominal aortic replacement. A 62-year-old male patient with aortic dissection underwent thoracoabdominal aortic replacement. He suddenly developed septic shock with esophageal perforation on the 6th postoperative day. Conservative therapy was employed, and he was discharged from the hospital. However, he suffered another attack of septic shock resulting from an esophago-mediastinal fistula. Gastrointestinal endoscopy revealed a suture thread beside an esophageal fistula. The patient consequently underwent esophagectomy. After removal of the esophagus, we found a suture thread with pledgets in the mediastinum and removed it. He recovered successfully thereafter. Esophago-mediastinal fistula associated with pledgets is a rare complication of thoracoabdominal aortic replacement. We believe that radical surgery can be an effective treatment. A review of the current literature did not reveal any similar cases. In this report, we discuss the clinical course of such a rare case.

Keywords

Esophageal fistula Aortic aneurysm Esophagectomy