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A two-stage reconstruction for aortoesophageal fistula after replacement of thoracic aorta for Stanford Type B dissecting aortic aneurysm: esophagectomy and a double-tract reconstruction using the pedicled jejunum: a case report and literature review

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Abstract

An aortoesophageal fistula (AEF) is a rare, potentially fatal condition, and esophagectomy is usually performed simultaneously with aortic surgery. However, esophageal reconstruction method has not been established. This case report describes a two-stage operation for AEF after replacement of thoracic aorta for Stanford Type B dissecting aortic aneurysm. A 61-year-old man who had underwent total arch replacement with frozen elephant trunk for Stanford Type B dissecting aortic aneurysm 3 years ago admitted to the hospital with high fever. Based on the computed tomography and endoscopic findings, he was diagnosed with having aortoesophageal fistula (AEF). After administration of antibiotics with fasting foods and drinks for a month, he underwent the second aortic replacement, thoracic esophagectomy, cervical esophagostomy, gastrostomy and omental wrapping. After 3 months, he underwent double-tract reconstruction using the pedicled jejunal transfer with supercharge and superdrainage via the subcutaneous route. After reconstruction surgery, the patient was doing well. Two-stage reconstruction was a safe procedure for AEF case who underwent aortic replacement, esophagectomy and omental wrapping. The pedicled jejunum reconstruction via subcutaneous route is an optional procedure for second reconstruction surgery.

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Abbreviations

AEF:

Aortoesophageal fistula

CRP:

C-reactive protein

CT:

Computed tomography

EGD:

Esophago-gastric-duodenal scope

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Acknowledgements

We are grateful to Dr. Toshihiko Satake, Dr. Mayu Muto, and Dr. Yui Tsunoda for helping us at the part of microvascular anastomosis.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Sho Sato, Chikara Kunisaki, Yusaku Tanaka, Kei Sato, Hiroshi Miyamoto & Norio Yukawa

  2. Department of Surgery, Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan

    Hiroko Nemoto & Keiji Uchida

  3. Department of Surgery, Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan

    Teppei Nishii

  4. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Takashi Kosaka, Hirotoshi Akiyama & Itaru Endo

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  1. Sho Sato
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  2. Chikara Kunisaki
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  3. Yusaku Tanaka
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  4. Kei Sato
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Contributions

SS, CK, NY, YT, KS, HM, TK, HA and IE designed this study. SS is the first author of this manuscript. CK is the corresponding author. SS, CK, NY, KU, HN, and TN performed the surgery. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Chikara Kunisaki.

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Conflict of interest

Sho Sato, Chikara Kunisaki, Yusaku Tanaka, Kei Sato, Hiroshi Miyamoto, Norio Yukawa, Hiroko Nemoto, Keiji Uchida, Teppei Nishii, Takashi Kosaka, Hirotoshi Akiyama and Itaru Endo declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient for being included in the study.

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Sato, S., Kunisaki, C., Tanaka, Y. et al. A two-stage reconstruction for aortoesophageal fistula after replacement of thoracic aorta for Stanford Type B dissecting aortic aneurysm: esophagectomy and a double-tract reconstruction using the pedicled jejunum: a case report and literature review. Clin J Gastroenterol 13, 722–727 (2020). https://doi.org/10.1007/s12328-020-01158-9

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  • DOI: https://doi.org/10.1007/s12328-020-01158-9

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