Endovascular Treatment of Aortoesophageal Fistula Caused by Ingestion of a Fragment of Beef Bone: Case Report and Review of the Literature

Sidinéia Santos da Rocha¹, Carlos Eduardo Nunes², Osmar Max Gonçalves Neves¹, Vinícius de Oliveira Menezes Bezerra¹ and José Aderval Aragão^3,

¹Medical Resident in the “Dr. José Calumby Filho” Vascular Surgery Service, Fundação Beneficência Hospital Cirurgia, Aracaju, Sergipe, Brazil

²Head of the “Dr. José Calumby Filho” Vascular Surgery Service, Fundação Beneficência Hospital Cirurgia, Aracaju, Sergipe, Brazil

³Department of Morphology and the Postgraduate Applied Health Science Programs, Federal University of Sergipe (UFS), and Titular Professor of the Medical School, Tiradentes University (UNIT), Aracaju, Sergipe, Brazil

Cite this paper

Sidinéia Santos da Rocha, Carlos Eduardo Nunes, Osmar Max Gonçalves Neves, Vinícius de Oliveira Menezes Bezerra and José Aderval Aragão. Endovascular Treatment of Aortoesophageal Fistula Caused by Ingestion of a Fragment of Beef Bone: Case Report and Review of the Literature. American Journal of Medical Case Reports. 2016; 4(12):378-383. doi: 10.12691/AJMCR-4-12-3

Abstract

Context: Aortoesophageal fistula is a rare but catastrophic complication that can occur either primarily or after aortic reconstruction. Because of its rarity, no standardized protocols for its diagnosis and treatment have been established. Objective: The objective of this study was to report on a case of aortoesophageal fistula caused by a fragment of beef bone, which was treated by means of an endoprosthesis in the descending thoracic aorta to control the bleeding. Case report: A 72-year-old female patient was initially admitted to the emergency service of a public hospital with dysphagia and intense pain in the dorsal region after having ingested a fragment of beef bone. Upper digestive endoscopy was performed to remove the foreign body. Nine days after the patient had been released, she was again admitted to the emergency service with back pain, voluminous hematemesis and signs of hypovolemia. Emergency angiotomography was performed, which revealed the presence of a pseudoaneurysm in the thoracic aorta just below the aortic arch that was suggestive of an aortoesophageal fistula. The patient was taken to the hemodynamics center and underwent an endovascular procedure to insert an endoprosthesis into the descending thoracic aorta, to control the bleeding. She was released after a hospital stay of 94 days, without further signs of infection or aortic bleeding. She evolved without symptoms during a follow-up of around 30 days, but then returned to the emergency service with persistent fever and signs of sepsis. She underwent left thoracotomy for drainage and debridement, but her condition worsened and she died during the immediate postoperative period. Conclusion: Aortoesophageal fistula is a serious clinical condition that needs to be dealt with early on, because of the risk of severe blood loss. Endovascular treatment is very important in this regard, since it promotes control over bleeding through an efficient and less invasive approach.

Keywords

aortoesophageal fistula, esophageal foreign body, endovascular stenting, upper gastrointestinal hemorrhage, abdominal aortic aneurysm, endoscopy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Hollander JE, Quick G. Aortoesophageal fistula: a comprehensive review of the literature. Am J Med. 1991 Sep; 91(3): 279-87.
[2]	Akashi H, Kawamoto S, Saiki Y, Sakamoto T, Sawa Y, Tsukube T, Kubota S, Matsui Y, Karube N, Imoto K, Yamanaka K, Kondo S, Tobinaga S, Tanaka H, Okita Y, Fujita H. Therapeutic strategy for treating aortoesophageal fistulas. Gen ThoracCardiovasc Surg. 2014 Oct; 62(10): 573-80.
[3]	Akin M, Yalcinkaya T, Alkan E, Arslan G, Tuna Y, Yildirim B. A Cause of Mortal Massive Upper Gastrointestinal Bleeding: Aortoesophageal Fistula. Med Arch. 2016 Feb; 70(1): 79-81.
[4]	Burks JA Jr, Faries PL, Gravereaux EC, Hollier LH, Marin ML. Endovascular repair of bleeding aortoenteric fistulas: a 5-year experience. J Vasc Surg. 2001Dec; 34(6): 1055-9.
[5]	Eren E, Keles C, Toker ME, Ersahin S, Erentug V, Guler M, Ipek G, Akinci E, Balkanay M, Yakut C. Surgical treatment of aortobronchial and aortoesophageal fistulae due to thoracic aortic aneurysm. Tex Heart Inst J. 2005; 32(4): 522-8.
[6]	Inoue T, Nishino T, Peng YF, Saga T. Successful one-stage operation of aortoesophageal fistula from thoracic aneurysm using a rifampicin-soaked synthetic graft. Interact CardiovascThorac Surg. 2008 Apr; 7(2): 322-4.
[7]	Wei Y, Chen L, Wang Y, Yu D, Peng J, Xu J. Proposed management protocol for ingested esophageal foreign body and aortoesophageal fistula: a single-center experience. Int J Clin Exp Med. 2015 Jan 15; 8(1): 607-15.
[8]	Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8; 345(19): 1368-77.
[9]	Kawamoto S, Sato M, Motoyoshi N, Kumagai K, Adachi O, Saito T, Teshima J, Kamei T, Miyata G, Saiki Y. Outcomes of a staged surgical treatment strategy for aortoesophageal fistula. Gen ThoracCardiovasc Surg. 2015 Mar; 63(3): 147-52.
[10]	Zhang X, Liu J, Li J, Hu J, Yu F, Li S, Yang X. Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body. Laryngoscope. 2011 Feb; 121(2): 267-72.
[11]	Mosquera VX, Marini M, Pombo-Felipe F, Gómez-Martinez P, Velasco C, Herrera-Noreña JM, Cuenca-Castillo JJ. Predictors of outcome and different management of aortobronchial and aortoesophageal fistulas. J ThoracCardiovasc Surg. 2014 Dec; 148(6): 3020-6.e1-2.
[12]	Kubota S, Shiiya N, Shingu Y, Wakasa S, Ooka T, Tachibana T, Yamauchi H, Ishibashi Y, Oba J, Matsui Y. Surgical strategy for aortoesophageal fistula in the endovascular era. Gen Thorac Cardiovasc Surg. 2013 Oct; 61(10): 560-4.
[13]	Xi EP, Zhu J, Zhu SB, Liu Y, Yin GL, Zhang Y, Zhang XM, Dong YQ. Surgical treatment of aortoesophageal fistula induced by a foreign body in the esophagus: 40 years of experience at a single hospital. SurgEndosc. 2013 Sep;27(9):3412-6.
[14]	Chiesa R, Kahlberg A, Tshomba Y, Marone EM, Marrocco-Trischitta MM, Melissano G. Endovascular repair of aortoesophageal and aortobronchial fistulae. Tex Heart Inst J. 2011; 38(6):655-7.
[15]	Dorweiler B, Weigang E, Duenschede F, Pitton MB, Dueber C, Vahl CF. Strategies for endovascular aortic repair in aortobronchial and aortoesophageal fistulas. ThoracCardiovasc Surg. 2013 Oct; 61(7): 575-80.
[16]	Chen X, Li J, Chen J, Zhou Y, Zhang Y, Ding H, Huang S, Zhang Z. A combined minimally invasive approach for the treatment of aortoesophageal fistula caused by the ingestion of a chicken bone: case report and literature review. Clinics (Sao Paulo). 2012; 67(2): 195-7.
[17]	Kahlberg A, Tshomba Y, Marone EM, Castellano R, Melissano G, Chiesa R. Current results of a combined endovascular and open approach for the treatment of aortoesophageal and aortobronchial fistulae. Ann Vasc Surg. 2014 Oct; 28(7): 1782-8.