Mohamed Saifullah, Patel Akshay J, Iqbal Yassir H, Ranasinghe Aaron
Department of Cardiac Surgery, Queen Elizabeth Hospital, Birmingham, Mindelsohn Way, Edgbaston, Birmingham, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, UK.
J Surg Case Rep. 2020 Jul 14;2020(7):rjaa135. doi: 10.1093/jscr/rjaa135. eCollection 2020 Jul.
Aorto-oesophageal fistula is a rarely described but life-threatening complication presenting with upper gastrointestinal haemorrhage. We present a case of a 58-year-old gentleman who presented to a peripheral hospital with a short duration of haematemesis and melaena and recent onset symptoms of dysphagia. This gentleman had a past medical history of alcohol excess and a history of trauma following a road traffic accident 38 years ago. Initial computer tomography scan demonstrated a large saccular aneurysm arising from the descending thoracic aorta adjacent to the oesophagus. The patient underwent radiological stenting of the large aneurysm with thoracic endovascular aortic replacement procedure. Follow-up computerized tomography (CT) angiography demonstrated satisfactory appearances of the thoracic aortic stent graft with no evidence of endo-leak. The triad of dysphagia, occult gastrointestinal blood loss and CT findings of a large aneurysm should prompt diagnosis or aorto-oesophageal fistula until proven otherwise.
主动脉食管瘘是一种罕见但危及生命的并发症，表现为上消化道出血。我们报告一例58岁男性患者，他因短期呕血、黑便及近期出现吞咽困难症状就诊于一家基层医院。该患者既往有酗酒史，38年前曾发生道路交通事故并有创伤史。初始计算机断层扫描显示降主动脉邻近食管处有一个大的囊状动脉瘤。患者接受了大动脉瘤的放射学支架置入及胸主动脉腔内修复术。随访计算机断层血管造影显示胸主动脉支架移植物外观良好，无内漏迹象。吞咽困难、隐匿性胃肠道失血及大动脉瘤的CT表现三联征应提示主动脉食管瘘的诊断，除非有其他证据排除。
