Proposed management protocol for ingested esophageal foreign body and aortoesophageal fistula: a single-center experience.

OBJECTIVE

Aortoesophageal fistula (AEF) is a life-threatening complication of foreign body ingestion. The primary objective of this study was to describe a new management protocol for infected AEFs, which combines endovascular stent grafting and mediastinal drainage using video-assisted thoracoscopic surgery (VATS).

METHODS

The authors analyzed the clinical data of 22 patients with ingested foreign bodies retrospectively, developed a classification system based on multidetector computed tomography (MDCT) findings for esophageal injuries induced by foreign body ingestion, and used this system and the clinical presentation to guide treatment.

RESULTS

Depending on the MDCT findings, the esophageal injuries were divided into four grades: Grade I, non-penetrating injury (six patients); Grade II, penetrating injury with minimal infection (five patients); Grade III, potential AEF (five patients); and Grade IV, definite AEF (six patients). When a foreign body was visible on MDCT, a distance of ≤ 2 mm between the foreign body and aortic wall indicated potential or definite AEF. When no foreign body was visible, a typical clinical presentation, especially sentinel hemorrhage, and MDCT findings were used to establish the diagnosis. Only three Grade IV patients who underwent open surgery died of severe hemorrhage within 24 h postoperatively. The others patients had a good outcome with different treatment.

CONCLUSIONS

The authors' experience indicates that MDCT was useful to classify esophageal injuries caused by foreign body ingestion which predicted the risk of AEF; endovascular stent grafting and VATS-guided mediastinal drainage would be a safe and minimally invasive method for treating patients with AEF and has the potential for improved treatment options for AEFs.