Zhang Yu-Yan, Li Shan, Yuan Xiang-Lei, Hu Bing
Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan Province, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China.
BMC Gastroenterol. 2021 Feb 2;21(1):46. doi: 10.1186/s12876-021-01624-9.
Aorto-esophageal fistula (AEF) caused by foreign bodies ingestion is a rare but devastating disorder. Thoracic endovascular aortic repair (TEVAR) has become a widely accepted intervention for treating aorto-esophageal fistulas. As for post-TEVAR esophageal defect, secondary esophagectomy has been the recommended choice for most of the AEFs, but there is no general consensus with regard to the need of secondary surgeries for patients in the absence of clear signs of reinfection or bleeding. We herein presented a case of an AEF caused by fishbone ingestion, after successful TEVAR, the esophageal lesion was closed endoscopically.
A 38-year-old male presented with esophageal fistula for 4 months. He was diagnosed with AEF because of Chiari's triad after fishbone ingestion 4 months ago. Emergency thoracic aortic stent implantation was done, and given broad spectrum antibiotics and blood transfusion. His symptoms were improved, and discharged with an esophageal fistula left to heal itself. Nevertheless, after 4 months, re-examination of esophago-gastro-duodenoscopy revealed that the diameter of the fistula was changed from 3 to 6 mm. He was then admitted to our hospital for esophageal fistula repair. Laboratory examinations and chest computed tomography showed no signs of active infection, and endoscopic closure of the fistula was achieved with 4 clips. After that, he was discharged and gradually returned to normal diet.
For AEFs in the absence of active infection with repaired aorta but persistent esophageal fistula, endoscopic closure by endoclips might be an effective treatment choice.
异物吞食导致的主动脉食管瘘（AEF）是一种罕见但极具破坏性的疾病。胸主动脉腔内修复术（TEVAR）已成为治疗主动脉食管瘘广泛接受的干预手段。至于TEVAR术后的食管缺损，对于大多数AEF患者，二期食管切除术一直是推荐的选择，但对于没有明确再感染或出血迹象的患者是否需要二期手术，尚无普遍共识。我们在此报告一例因鱼骨吞食导致的AEF病例，在成功进行TEVAR术后，通过内镜闭合了食管病变。
一名38岁男性因食管瘘4个月就诊。他在4个月前吞食鱼骨后因出现奇阿里三联征被诊断为AEF。进行了急诊胸主动脉支架植入，并给予广谱抗生素和输血治疗。他的症状有所改善，出院时食管瘘自行愈合。然而，4个月后，再次进行食管胃十二指肠镜检查发现瘘口直径从3毫米变为6毫米。随后他因食管瘘修复入院。实验室检查和胸部计算机断层扫描显示无活动性感染迹象，通过4个夹子实现了瘘口的内镜闭合。之后，他出院并逐渐恢复正常饮食。
对于已修复主动脉但无活动性感染且持续存在食管瘘的AEF患者，内镜下用夹子闭合可能是一种有效的治疗选择。
