Mid and South Essex Vascular Unit, Mid and South Essex Hospitals NHS Foundation Trust, Basildon, Essex, UK.
General Surgery, Mid and South Essex NHS Foundation Trust, Chelmsford, Essex, UK.
BMJ Case Rep. 2022 Jun 1;15(6):e246539. doi: 10.1136/bcr-2021-246539.
A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially revealed profuse bleeding at 20cm from the incisors, initially treated with an oesophageal covered stent. Following ongoing haematemesis, a thoracic and abdominal CT angiogram demonstrated an aorto-oesophageal fistula, which was successfully treated with a thoracic endograft and left tube thoracostomy. The patient remains well to 1 year. This is the first case to demonstrate successful use of covered stents in both the aorta to stop exsanguination, as well as the oesophagus to prevent mediastinitis and avoid the need for thoracotomy and hypothermic circulatory arrest in a critically ill patient.
一位 50 多岁的女性因大量呕血到急诊科就诊，她在 3 年前吞下了一副假牙。最初的内镜检查发现在门牙 20 厘米处有大量出血，最初采用食管覆膜支架进行治疗。尽管持续呕血，但胸部和腹部 CT 血管造影显示主动脉食管瘘，通过胸主动脉内支架和左侧胸腔引流术成功治疗。患者在 1 年内情况良好。这是首例成功使用覆膜支架治疗主动脉以止血，以及治疗食管以预防纵隔炎并避免在危重症患者中进行开胸手术和低温循环停止的病例。
