Yunus Kushedison, Ahmadzai Hasib, Dunlop Eleanor Noreen, Thomson Andrew
Gastroenterology and Hepatology Unit, The Canberra Hospital, Australian Capital Territory, Canberra, Australia.
Case Rep Gastrointest Med. 2025 Jan 10;2025:6277906. doi: 10.1155/crgm/6277906. eCollection 2025.
We present a case of an 80-year-old female who presented with chest pain, vomiting and night sweats a few weeks post thoracic endovascular aortic aneurysm repair (TEVAR). A computed tomography (CT) scan demonstrated a type 1B endoleak for which she underwent a repeat TEVAR. Postoperatively, she developed fever, dysphagia, haematemesis and melaena. CT angiography subsequently confirmed an aorto-oesophageal fistula (AEF). Gastroscopy was performed to confirm this and found an ovoid oesophageal perforation with visible aortic graft and purulent fluid. Serial endoscopic oesophageal stents were placed and the patient recovered after an oesophageal Ultraflex stent was placed. Unfortunately, however, the patient was found unresponsive at home with black vomitus and in cardiac arrest and passed away 18 months after her initial endoscopic procedure. This case highlights that AEF is a complication following a TEVAR procedure. This can be managed temporarily with oesophageal stent placement and an Ultraflex stent in the longer term. However, oesophageal stent placement is not curative in cases of significant oesophageal perforation as it does not lead to lead to closure of a large defect.
我们报告一例80岁女性患者，在胸主动脉腔内修复术（TEVAR）后几周出现胸痛、呕吐和盗汗。计算机断层扫描（CT）显示为1B型内漏，为此她接受了再次TEVAR。术后，她出现发热、吞咽困难、呕血和黑便。CT血管造影随后证实了主动脉食管瘘（AEF）。进行胃镜检查以确诊，发现一个椭圆形食管穿孔，可见主动脉移植物和脓性液体。连续放置内镜食管支架，在放置食管Ultraflex支架后患者康复。然而，不幸的是，患者在家中被发现无反应，伴有黑色呕吐物，处于心脏骤停状态，在初次内镜手术后18个月去世。该病例强调AEF是TEVAR手术后的一种并发症。这可以通过临时放置食管支架和长期放置Ultraflex支架来处理。然而，在食管严重穿孔的情况下，食管支架置入并不能治愈，因为它不会导致大的缺损闭合。
