Aortoesophageal fistulas

Aorto-esophageal fistula is a rare and life-threatening complication. Primary aorto-esophageal fistula is usually caused by fistulization of an expanding atherosclerotic aneurysm into the esophagus or, less commonly, erosion of a reflux-associated esophageal ulcer into the aorta. Secondary aorto-esophageal fistula occurs after previous grafting of the descending aorta and represents a communication between the aorta and the esophagus, usually at one of the suture lines.

Patients with aorto-esophageal fistula present with massive hematemesis leading to exsanguination, often after a symptom-free interval. Patients may complain of a sentinel arterial hemorrhage, fever, and mid-thoracic pain. The definitive study to detect aorto-esophageal fistula is aortography. Other studies that may be useful include chest radiography and contrast studies of the esophagus.

Surgical repair is the only definitive lifesaving therapy for aorto-esophageal fistula. A delay in diagnosis is uniformly fatal. There have been seven reports of patients with secondary aorto-esophageal fistula, with only one long-term survivor ( Luketich ei a/ 1996b). This patient was successfully treated with an in situ polytetrafluoroethylene graft, esophagectomy, and substernal gastric bypass.

Chapter References

Asamura, H., Naruke, T., Tsuchiya, R., Goya, T., Kondo, H., and Suemasu, K. (1992). Bronchopleural fistulas associated with lung cancer operations. Journal of Thoracic and Cardiovascular Surgery, 104, 1456.

Asamura, H., Naruke, T., Tsuchiya, R., Goya, T., Kondo, H., and Suemasu, K. (1992). Bronchopleural fistulas associated with lung cancer operations. Journal of Thoracic and Cardiovascular Surgery, 104, 1456.

Quit Smoking For Good

Quit Smoking For Good

Quit smoking for good! Stop your bad habits for good, learn to cope with the addiction of cigarettes and how to curb cravings and begin a new life. You will never again have to leave a meeting and find a place outside to smoke, losing valuable time. This is the key to your freedom from addiction, take the first step!

Get My Free Ebook


Post a comment