Abstract
Background
Aortoesophageal fistula (AEF) is a rare but usually fatal complication of a foreign body in the esophagus. Little effective therapy exists to cure an AEF induced by esophageal foreign body. This report describes the authors’ 40 years of experience treating patients with AEF caused by a foreign body and compares different treatments of patients and their clinical outcomes.
Methods
The treatments of five patients with AEF caused by esophageal foreign body impaction were recorded at Wuhan General Hospital of Guangzhou Command from 1970 to 2011. One of these five patients was managed with nonsurgical measures, whereas three were treated by surgery with cardiopulmonary bypass, and one was treated by surgery with endovascular stent-graft repair.
Results
All five AEF cases were confirmed by computed tomography, esophagogastroscopy, surgical findings, or two or both. The nonsurgically treated patient died of fatal hemorrhage. Another patient died during the postoperative period because of ventricular fibrillation (he had a history of coronary heart disease before the operation), and still another patient died of fatal hemorrhage during the surgery. The remaining two patients were completely cured by surgery: the one via traditional open thoracotomy with cardiopulmonary bypass and the other by surgery with endovascular stent-graft repair.
Conclusions
The authors’ experience indicates that early diagnosis and an aggressive surgical treatment without delay is the only form of effective therapy for AEF. Endovascular stent-graft repair may be a safe and feasible method for treating patients with AEF that has potential as an improved treatment option for AEF.
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Acknowledgments
The authors wish to thank Dian-Tang Zhang, Professor of Department of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command, for his technical guide of clinical operation.
Funding
This work was supported by grants from the Wuhan science and technology funded plan projects (No. 201161038346) and 2010 military clinical high-tech funded plan projects (No. 2010 gxjs036).
Disclosures
Er-Ping Xi, Jian Zhu, Shui-Bo Zhu, Yong Liu, Gui-Lin Yin, Yu Zhang, Xiao-Ming Zhang, and Yong-Qiang Dong have no conflicts of interest or financial ties to disclose.
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Er-Ping Xi and Jian Zhu contributed equally to this work and should be considered co-first authors.
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Xi, EP., Zhu, J., Zhu, SB. et al. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus: 40 years of experience at a single hospital. Surg Endosc 27, 3412–3416 (2013). https://doi.org/10.1007/s00464-013-2926-3
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DOI: https://doi.org/10.1007/s00464-013-2926-3