Subject(s)
Esophageal Fistula , Esophageal Perforation , Mediastinal Diseases , Stents , Humans , Mediastinal Diseases/surgery , Mediastinal Diseases/therapy , Mediastinal Diseases/complications , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Esophageal Fistula/therapy , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Esophageal Perforation/therapy , Pleural Diseases/surgery , Pleural Diseases/therapy , Pleural Diseases/etiology , Male , Respiratory Tract Fistula/surgery , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/therapy , Negative-Pressure Wound Therapy/methods , Middle Aged , Esophageal Diseases , Rupture, SpontaneousSubject(s)
Esophageal Fistula , Esophagectomy , Stents , Humans , Esophagectomy/adverse effects , Stents/adverse effects , Male , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Esophageal Fistula/therapy , Esophageal Neoplasms/surgery , Anastomosis, Surgical/adverse effects , Anastomotic Leak/surgery , Anastomotic Leak/etiology , Anastomotic Leak/therapy , Middle Aged , Esophagoscopy/methodsABSTRACT
Fistulas in the upper gastrointestinal (GI) tract are complex conditions associated with elevated morbidity and mortality. They may arise as a result of inflammatory or malignant processes or following medical procedures, including endoscopic and surgical interventions. The management of upper GI is often challenging and requires a multidisciplinary approach. Accurate diagnosis, including endoscopic and radiological evaluations, is crucial to build a proper and personalized therapeutic plan, that should take into account patient's clinical conditions, time of onset, size, and anatomical characteristics of the defect. In recent years, several endoscopic techniques have been introduced for the minimally invasive management of upper GI fistulas, including through-the-scope and over-the-scope clips, stents, endoscopic suturing, endoluminal vacuum therapy (EVT), tissue adhesives, endoscopic internal drainage. This review aims to discuss and detail the current available endoscopic techniques for the treatment of upper GI fistulas.
Subject(s)
Endoscopy, Gastrointestinal , Gastric Fistula , Humans , Endoscopy, Gastrointestinal/methods , Gastric Fistula/therapy , Gastric Fistula/surgery , Stents , Treatment Outcome , Esophageal Fistula/therapy , Esophageal Fistula/surgery , Esophageal Fistula/diagnostic imaging , Drainage/instrumentation , Drainage/methods , Upper Gastrointestinal Tract/diagnostic imagingABSTRACT
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Rupture , Endovascular Procedures , Esophageal Fistula , Esophageal Perforation , Humans , Female , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Aged , Endovascular Procedures/methods , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/surgery , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Vascular Fistula/surgery , Vascular Fistula/etiology , Blood Vessel Prosthesis Implantation , Salvage Therapy/methods , Animals , Hematemesis/etiology , Aortic Diseases/surgery , Aortic Diseases/etiology , Aorta, Thoracic/surgery , Treatment Outcome , Fishes , Endovascular Aneurysm RepairABSTRACT
Broncho-esophageal fistula (BEF) is a severe yet relatively rare connection between the bronchus and esophagus usually caused by esophageal and pulmonary malignancies. We present a case report of a 49-year-old man diagnosed with terminal lung carcinoma who developed a BEF. The thoracic computed tomography scan detected a mass in the left bronchi that partially covers and disrupts the bronchial contour in certain regions and extends to the esophageal wall. After thoroughly evaluating alternative treatment approaches, we opt for the stenting procedure due to the advanced stage of the tumor and the significantly diminished quality of life. The treatment involves the use of a partially covered metal stent that is known to exhibit lower potential to migrate. The treatment is highly successful, resulting in a significant enhancement of the patient's quality of life, a lengthening in his survival, and the ability to pursue additional palliative treatment options. In contrast to the typical prosthesis implantation, our procedure uses a direct endoscopic visualization for the proximal deployment of a partially covered stent, offering a cost-effective and radiation-free alternative that can be particularly beneficial for BEF patients in facilities without radiology services.
Subject(s)
Bronchial Fistula , Esophageal Fistula , Stents , Humans , Male , Middle Aged , Esophageal Fistula/surgery , Esophageal Fistula/etiology , Bronchial Fistula/surgery , Lung Neoplasms/surgery , Treatment Outcome , Tomography, X-Ray Computed/methodsABSTRACT
Vascular rings are unusual congenital malformations. Among them, double aortic arch (DAA) is often difficult to diagnose due to its low incidence of symptoms. DAA can be associated with tracheal or esophageal compression and, in severe cases, could require tracheal intubation or chronic use of a nasogastric tube. This scenario favors the development of aortotracheal fistulas (ATF) or aortoe-sophageal fistulas (AEF). OBJECTIVE: To present a clinical case with an unusual association of DAA with ATF and to reinforce the importance of maintaining high diagnostic suspicion in patients with massive aerodigestive bleeding without an obvious source. CLINICAL CASE: A 32-week preterm newborn who required prolonged mechanical ventilation and presented intermittent episodes of massive oropharyngeal bleeding with hemodynamic compromise associated with lower airway obstruction without pulmonary hemorrhage. The patient underwent upper endoscopy and exploratory laparotomy without evidence of bleeding. Flexible nasopharyngolaryngoscopy and direct laryngoscopy also showed no abnormalities. A CT angiography showed complete DAA with indentation of the left dominant arch over the trachea, without severe stenosis or evidence of a fistula. AEF was suspected, so exploratory surgery was considered. However, the patient died before surgery due to a massive pulmonary hemorrhage. The autopsy revealed the presence of ATF. CONCLUSIONS: In patients with massive aerodigestive bleeding without an obvious source, the presence of DAA and possible AEF/ ATF should be considered. Imaging studies have a poor performance for this diagnosis, so surgery should be considered for diagnosis and treatment in these patients.
Subject(s)
Esophageal Fistula , Vascular Ring , Humans , Infant, Newborn , Vascular Ring/complications , Vascular Ring/surgery , Esophageal Fistula/diagnosis , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Gastrointestinal Hemorrhage/etiologyABSTRACT
BACKGROUND: Aortoesophageal fistula (AEF) is a rare condition characterized by communication between the aorta and esophagus. AEF caused by an esophageal foreign body is even rare, and there is currently no recommended standard treatment protocol. We report a case of delayed aortic rupture after the endoscopic removal of a fish bone, which was successfully treated with a combined approach of vascular stenting and thoracic surgery. CASE PRESENTATION: A 33-year-old man presented to the hospital after experiencing chest discomfort for 3 days following the accidental ingestion of a fish bone. Under endoscopic guidance, the fish bone was successfully removed, and the patient was subsequently admitted for medical therapy. On the fourth postoperative day, the patient suddenly developed hematemesis, and chest computed tomography angiography revealed the presence of an AEF. This necessitated urgent intervention; hence, thoracic surgery was performed and a vascular-covered stent was placed. Following the surgical procedure, the patient received active medical treatment, recovered well, and was successfully discharged from the hospital. CONCLUSIONS: In patients with esophageal perforation caused by foreign bodies, hospitalization for observation, computed tomography angiography examination, early use of antibiotics, and careful assessment of aortic damage are advised. Thoracic endovascular aortic repair and esophageal rupture repair may have benefits for the treatment of AEF.
Subject(s)
Aortic Diseases , Esophageal Fistula , Vascular Fistula , Male , Animals , Humans , Adult , Thoracic Surgery, Video-Assisted/adverse effects , Aortic Diseases/surgery , Aortic Diseases/complications , Esophageal Fistula/surgery , Esophageal Fistula/complications , Gastrointestinal Hemorrhage , Stents/adverse effects , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology , Vascular Fistula/surgeryABSTRACT
Aorto-esophageal fistula (AEF) due to esophageal cancer (EC) is a life-threatening condition characterized by sudden hemorrhage, which often causes sudden death. To evaluate the efficacy and safety of thoracic endovascular aortic repair (TEVAR) for AEF due to EC, we performed a systematic review and meta-analysis. We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi-Web (the databases of the Japan Medical Abstract Society), and CiNii (Academic information search service of the National Institute of Information from Japan) from January 2000 to November 2023 for articles about TEVAR for an emergent aortic hemorrhage (salvage TEVAR [S-TEVAR]), and the prophylactic procedure (P-TEVAR). Six studies (140 cases) were eligible for meta-analysis. The 90-day mortality of S-TEVAR and P-TEVAR was 40% (95% CI 23-60, I2 = 36%) and 8% (95% CI 3-17, I2 = 0%), respectively. Post-S-TEVAR hemorrhagic and infectious complications were 17% (95% CI 3-57, I2 = 71%) and 20% (95% CI 5-57, I2 = 66%), respectively. Post-P-TEVAR hemorrhagic and infectious complications were 2% (95% CI 0-10, I2 = 0%) and 3% (95% CI 1-12, I2 = 0%), respectively. TEVAR for AEF due to EC may be a useful therapeutic option to manage or prevent hemorrhagic oncological emergencies.
Subject(s)
Aorta, Thoracic , Aortic Diseases , Endovascular Aneurysm Repair , Esophageal Fistula , Esophageal Neoplasms , Vascular Fistula , Aged , Female , Humans , Male , Middle Aged , Aorta, Thoracic/surgery , Aortic Diseases/etiology , Aortic Diseases/surgery , Endovascular Aneurysm Repair/adverse effects , Endovascular Aneurysm Repair/methods , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Esophageal Neoplasms/surgery , Esophageal Neoplasms/complications , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Treatment Outcome , Vascular Fistula/surgery , Vascular Fistula/etiologyABSTRACT
INTRODUCTION: Whether airway-compromised airway-esophageal fistula (AEF) patients should undergo combined airway and esophageal stenting is controversial. This study was designed to evaluate the survival prognosis and poststent interventions in AEF patients with airways compromised by advanced malignancy with or without airway stents. METHODS: A retrospective analysis of the medical records, survival times, and poststent interventions of 17 patients with or without airway stents was performed. RESULTS: The causes of AEF were esophageal cancer (11/17, 64.7%), lung cancer (6/17, 29.4%), and thyroid cancer (1/17, 5.9%). All patients received a nasogastric tube (n = 12) or underwent gastrostomy (n = 5) to resume enteral nutrition. Thirteen patients underwent airway stent insertion (13/17, 76.5%), whereas four patients did not. Four patients with a high risk of stent migration received external stent fixation to the trachea. Three of the patients with stents suffered severe granulation tissue formation and needed repeated bronchoscopy interventions. In the stented group, none of the patients developed stent migration, and the overall median survival time was 9 months, compared with 1.25 months in the nonstented group (P = 0.04). Cox proportional hazards regression revealed that stent insertion, nasogastric tube insertion, and transcatheter bronchial artery chemoembolization were protective factors against death, whereas surgery-related fistula, fistula larger than 2 cm, continued chemotherapy, and age were risk factors for poor survival (P < 0.05). CONCLUSION: In airway-compromised AEF patients, airway stents and nasogastric tubes are probably the preferred treatments. Airway stenting is tolerable, and routine weekly poststent bronchoscopy is needed in the first month and depending on respiratory symptoms thereafter.
Subject(s)
Esophageal Fistula , Esophageal Neoplasms , Humans , Retrospective Studies , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Esophageal Neoplasms/etiology , Esophageal Neoplasms/pathology , Esophageal Neoplasms/therapy , Stents/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Aortoesophageal fistula (AEF) is an extremely rare and highly fatal complication leading to a high risk of morbidity and mortality. Successful management of AEF after esophagectomy for esophageal carcinoma has rarely been reported in the literature. CASE PRESENTATION: Here we present a rare case of a 44-year-old female with complications of AEF after esophagectomy for esophageal carcinoma, mainly presented as vomiting of blood. Both computed tomographic and computed tomography angiography of the chest showed bilateral pleural effusion and atelectasis, while gastroscopy showed large gastrointestinal bleeding. Emergency surgery was performed that included the removal of the mediastinal abscess, left lower pulmonary wedge resection, and thoracic endovascular aortic repair (TEVAR), followed by supportive treatment. The surgery went successful, and the patient was followed up for 1 year after discharge and showed good recovery. We also reviewed previous literature on the history, causes, pathophysiology, clinical presentation, diagnosis, and treatment of AEF after esophagectomy for esophageal adenocarcinoma. CONCLUSIONS: In our case, thoracotomy combined with TEVAR was effective in treating AEF after esophagectomy for esophageal adenocarcinoma. This case provides successful experiences for clinical diagnosis and treatment of AEF after esophagectomy for esophageal carcinoma.
Subject(s)
Adenocarcinoma , Aortic Diseases , Carcinoma , Esophageal Fistula , Vascular Fistula , Adult , Female , Humans , Adenocarcinoma/surgery , Adenocarcinoma/complications , Aortic Diseases/surgery , Aortic Diseases/complications , Carcinoma/surgery , Endovascular Aneurysm Repair , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Esophagectomy/adverse effects , Gastrointestinal Hemorrhage , Vascular Fistula/etiology , Vascular Fistula/surgeryABSTRACT
Our objective was to assess the safety and efficacy of 3 tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a noninvasive treatment from February 2013 to July 2022. Patients received 3 tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal-covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal-covered stents were removed after fistula healing. All patients received 3 tubes placement and 11 patients with luminal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no procedure-related death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for a median duration of 1.6 months (interquartile ranges [IQR] 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. A noninvasive treatment of 3 tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.
Subject(s)
Esophageal Fistula , Gastric Fistula , Pleural Diseases , Humans , Abscess/therapy , Retrospective Studies , Treatment Outcome , Stomach , Pleural Diseases/etiology , Pleural Diseases/surgery , Stents , Esophageal Fistula/etiology , Esophageal Fistula/surgeryABSTRACT
Aortoesophageal fistula (AEF) is a rare but life-threatening pathology. We report a case of a primary AEF that was successfully managed with temporary thoracic endovascular aortic repair (TEVAR) and esophagectomy with video-assisted thoracoscopic surgery. A 73-year-old man was transferred to the emergency department with a complaint of hematemesis. A computed tomography scan identified an AEF due to aortic aneurysm. We placed a stent using TEVAR for the purpose of hemodynamic stasis, and the operation was performed 23 h after admission. Right video-assisted thoracoscopic esophagectomy (VATS-E) was chosen, and a cervical esophagostomy and a feeding gastrostomy tube was constructed. Infection had been effectively controlled postoperatively. Four months after the first operation, we performed esophageal reconstruction. At the 70-month follow-up examination, the patient had no signs of mediastinitis. VATS-E immediately after hemostabilization by TEVAR is useful management for primary AEF.
Subject(s)
Aortic Diseases , Blood Vessel Prosthesis Implantation , Esophageal Fistula , Male , Humans , Aged , Esophagectomy , Endovascular Aneurysm Repair , Blood Vessel Prosthesis Implantation/adverse effects , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgery , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Fistula/surgerySubject(s)
Aortic Diseases , Blood Vessel Prosthesis Implantation , Esophageal Fistula , Humans , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Gastrointestinal Hemorrhage , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgeryABSTRACT
BACKGROUND: Esophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication. METHODS: We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review. RESULTS: A total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5-40%, cryoballoon 3-25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention. CONCLUSIONS: Esophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Esophageal Fistula , Esophageal Perforation , Humans , Esophageal Perforation/complications , Esophageal Perforation/surgery , Esophageal Fistula/epidemiology , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Prognosis , Catheter Ablation/adverse effects , Catheter Ablation/methods , Heart Atria/surgerySubject(s)
Aortic Aneurysm, Thoracic , Aortic Diseases , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Esophageal Fistula , Vascular Fistula , Humans , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Endovascular Aneurysm Repair , Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , StentsABSTRACT
Atrio-esophageal fistula (AEF) is a rare (0.02-0.1%) complication of radiofrequency ablation for atrial fibrillation and is associated with high mortality. It typically presents between 2 and 6 weeks after catheter ablation. AEF was reported to be the second complication as cause of death after radiofrequency ablation with a mortality rate of 71%. Common clinical features of AEF include dysphagia, nausea, heartburn, hematemesis or melena, high fever, sepsis, pericardial or pleural effusions, mediastinitis, seizures, and stroke. Once the diagnosis of AEF is made, early surgical repair is mandatory. Herein, we report a case of a AEF treated surgically without extracorporeal circulation.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Esophageal Fistula , Heart Diseases , Humans , Atrial Fibrillation/complications , Heart Atria/surgery , Esophageal Fistula/etiology , Esophageal Fistula/surgery , Esophageal Fistula/diagnosis , Heart Diseases/etiology , Heart Diseases/surgery , Heart Diseases/diagnosis , Catheter Ablation/adverse effectsABSTRACT
BACKGROUND: Aortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction. CASE PRESENTATION: This case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results. CONCLUSIONS: For postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.