Diagnosis and treatment of 32 cases with aortoesophageal fistula due to esophageal foreign body.

OBJECTIVES/HYPOTHESIS: Aortoesophageal fistula is a rare but life-threatening complication of foreign body ingestion. In spite of several strategies for treatment, there is little consensus regarding the optimal management of the entity. In this article, we present our experience in the diagnosis and treatment of patients with aortoesophageal fistula.

STUDY DESIGN

Retrospective study.

METHODS

A total of 3,209 admissions due to esophageal foreign body impaction were recorded in Second Xiangya Hospital between 1963 and 2010. Of these, 32 cases were complicated with aortoesophageal fistula. In these 32 patients, 19 were treated by open surgery and 13 were managed with nonsurgical measures. We compared different treatments of the patients and their clinical outcomes.

RESULTS

Foreign body and aortoesophageal fistula were found in all of these 32 cases in imaging examination and/or surgery. Three patients were completely cured and 16 patients died of fatal hemorrhage from the group of patients with surgical management. All 13 nonsurgically treated cases died.

CONCLUSIONS

Early diagnosis and an aggressive surgical treatment without delay is the only form of effective therapy for the condition of aortoesophageal fistula. Imaging examination is helpful in diagnosis. In particular, three-dimensional computerized tomography is a safe, simple, and noninvasive examination method that has high sensitivity and specificity for the early diagnosis of aortoesophageal fistula.