Uittenbogaart M, Sosef M N, van Bastelaar J
Department of Surgery, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
Case Rep Surg. 2014;2014:614312. doi: 10.1155/2014/614312. Epub 2014 Dec 2.
Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.
胃主动脉瘘形成是食管切除术后一种非常罕见的并发症，在大多数情况下会导致猝死。我们报告了一例65岁男性食管腺癌患者，该患者接受了新辅助放化疗，随后行微创经胸食管切除术并采用胃管重建和胸内吻合术。术后过程顺利且出院后，患者在术后第23天报告有血液反流。内镜检查发现食管壁上有一个附着的血凝块，血凝块移位后导致大出血。尸检确定死亡原因是胃主动脉瘘导致的大量出血。出血的突然发作使得这种情况特别难以治疗。识别诸如胸痛或上腹痛、血液反流、或便血或黑便等警示信号对于瘘的早期检测至关重要，可能会改善患者的预后。
