Zhong Xue-Qing, Li Guo-Xiong
Department of Gastroenterology and Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310015, Zhejiang Province, China.
World J Clin Cases. 2022 Apr 26;10(12):3814-3821. doi: 10.12998/wjcc.v10.i12.3814.
Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.
A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.
Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.
主动脉食管瘘（AEF）是上消化道出血的一种罕见但危及生命的病因。仅有少数几例食管癌所致AEF成功治疗的病例报道。本研究旨在报告1例通过血管腔内主动脉修复术治疗的AEF病例并复习相关文献。
一名66岁男性因上消化道出血就诊于我院急诊科，主诉胸痛、发热和呕血6小时。他在6小时前呕吐了400毫升鲜红色血液，并经历了严重胸痛。他既往有晚期食管癌病史。他接受过放化疗，但因不耐受在8个月前停止。胸部增强计算机断层扫描显示食管与降主动脉之间有连通以及降主动脉假性动脉瘤。根据症状和影像学表现，AEF是我们的首要考虑。患者接受了主动脉血管造影，结果显示为AEF和降主动脉假性动脉瘤。对降主动脉进行了急诊经皮胸主动脉腔内修复术（TEVAR），TEVAR术后出血得到控制。他接受了抗生素治疗，治疗后出院。然而，他在TEVAR术后2个月因癌症进展死亡。
尽管AEF是一种致命疾病，但及时诊断和TEVAR可能成功控制出血。
