Secondary Rupture of Aorta following the Surgical Management of Aortoesophageal Fistula

A patient suffering from an aortoesophageal fistula (AEF) caused by a fish bone, was treated in our institute in 2000. The operation was successful and the patient had an uneventful early postoperative course. However, the patient died of frank hematemesis on the 6th postoperative day due to secondary rupture of the aorta. The lessons learnt and surgical efforts to manage AEF caused by an esophageal foreign body are discussed.

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Esophageal Foreign Body Causing Direct Aortic Injury

Canadian Journal of Gastroenterology ◽

10.1155/2003/948232 ◽

2003 ◽

Vol 17 (2) ◽

pp. 115-117 ◽

Cited By ~ 16

Author(s):

ECS Lam ◽

JA Brown ◽

JS Whittaker

Keyword(s):

Foreign Body ◽

Esophageal Perforation ◽

Foreign Bodies ◽

Aortic Injury ◽

Fish Bone ◽

Aortoesophageal Fistula ◽

Esophageal Foreign Body ◽

Arterial Bleeding ◽

History Of ◽

Tomography Scan

Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

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Aortic penetration due to a fish bone: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01325-6 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Daming Jiang ◽

Yi Lu ◽

Yigong Zhang ◽

Zhanglong Hu ◽

Haifeng Cheng

Keyword(s):

Foreign Body ◽

Fish Bone ◽

Term Treatment ◽

Aortoesophageal Fistula ◽

First Case ◽

Long Term Treatment ◽

Swallowing Pain ◽

Life Threatening ◽

Sharp Foreign Body

Abstract Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

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