Liao Yiran, Yu Shishi, Shen Neng, Liao Zhongli, Wang Jiong
Phase I Clinical Research Center, Chongqing University Cancer Hospital, Chongqing, China.
Gastroenterology, Chongqing University Cancer Hospital, Chongqing, China.
Medicine (Baltimore). 2025 Jan 17;104(3):e41292. doi: 10.1097/MD.0000000000041292.
Aortoesophageal fistula (AEF) is an exceedingly rare yet critically life-threatening condition, with mortality rates nearing 100% if not addressed promptly. AEF often develops in the context of thoracic aortic aneurysms, esophageal malignancies, or as a complication of foreign body ingestion and prior thoracic aortic surgeries. This study reports an exceptionally severe and clinically rare case of AEF associated with a pseudaneurysm induced by esophageal stenting. By disseminating this case, we aim to heighten awareness of AEF and emphasize the necessity for meticulous decision-making during esophageal stent placement, along with the importance of vigilant postoperative monitoring to enable early intervention.
A 70-year-old male presented with "food obstruction" and was subsequently diagnosed with esophageal malignancy. To alleviate the obstruction, he underwent esophageal stenting. Fifty-five days postprocedure, he experienced a sudden onset of "chest pain, vomiting of dark red blood, and melena," prompting hospitalization for "gastrointestinal bleeding."
Urgent computed tomography angiography revealed the emergence of a new pseudaneurysm at the lateral aspect of the esophageal stent, with direct communication between the aneurysm and the adjacent esophagus, raising the suspicion of AEF.
An urgent multidisciplinary emergency team was convened to execute critical interventions, including endoluminal stenting of the esophagus and thoracic endovascular aortic repair.
The patient suffered a sudden and massive hematemesis, estimated at approximately 3000 mL, leading to his subsequent demise.
AEF is a rare cause of upper gastrointestinal bleeding. For patients suspected of AEF, it is imperative to conduct prompt and thorough computed tomography angiography while initiating an emergency surgical alert. The proximity of esophageal stents to the aorta may significantly elevate the risk of AEF; thus, a comprehensive risk assessment should precede stent placement in cases involving tumors adjacent to the aorta. Furthermore, postoperative surveillance is crucial to monitor potential aortic invasion by the tumor or the development of an aneurysm near the esophagus, facilitating timely intervention.
主动脉食管瘘（AEF）是一种极其罕见但危及生命的疾病，如果不及时治疗，死亡率接近100%。AEF通常发生在胸主动脉瘤、食管恶性肿瘤的背景下，或作为异物摄入和先前胸主动脉手术的并发症。本研究报告了一例与食管支架诱导的假性动脉瘤相关的异常严重且临床罕见的AEF病例。通过传播此病例，我们旨在提高对AEF的认识，并强调在食管支架置入过程中进行细致决策的必要性，以及术后密切监测以实现早期干预的重要性。
一名70岁男性因“食物梗阻”就诊，随后被诊断为食管恶性肿瘤。为缓解梗阻，他接受了食管支架置入术。术后55天，他突然出现“胸痛、呕吐暗红色血液和黑便”，因“消化道出血”住院。
紧急计算机断层扫描血管造影显示食管支架外侧出现新的假性动脉瘤，动脉瘤与相邻食管直接相通，怀疑为AEF。
紧急召集多学科应急小组进行关键干预，包括食管腔内支架置入和胸主动脉腔内修复。
患者突然大量呕血，估计约3000毫升，随后死亡。
AEF是上消化道出血的罕见原因。对于疑似AEF的患者，在启动紧急手术警报的同时，必须迅速进行全面的计算机断层扫描血管造影。食管支架与主动脉的接近可能显著增加AEF的风险；因此，在涉及主动脉附近肿瘤的病例中，在支架置入前应进行全面的风险评估。此外，术后监测对于监测肿瘤对主动脉的潜在侵犯或食管附近动脉瘤的发展至关重要，有助于及时干预。
