Shah Maya, Liu Peter H, Iglesias Nicholas, Lee Raphael, Livingstone Alan S
University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136, United States.
Department of Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136, United States.
J Surg Case Rep. 2025 Aug 29;2025(8):rjaf674. doi: 10.1093/jscr/rjaf674. eCollection 2025 Aug.
Aortoenteric fistula (AEF) is a rare but catastrophic complication following esophagectomy, often resulting in massive upper gastrointestinal bleeding and high mortality. While most cases occur early in the postoperative period, delayed presentations remain poorly understood. We report the case of a 54-year-old woman who underwent esophagectomy and gastric pull-up for mid-esophageal squamous cell carcinoma. Nine months postoperatively, the patient presented with hematemesis, hemorrhagic shock, and died despite resuscitative efforts. Autopsy revealed a 0.9 cm erosion in the descending thoracic aorta with adjacent ulceration of the gastric conduit and bacterial infiltration consistent with a thoracic AEF. This case illustrates a rare, delayed presentation of AEF confirmed by post-mortem analysis. It highlights the need for ongoing clinical vigilance even in patients with initially uncomplicated recoveries.
主动脉肠瘘（AEF）是食管切除术后一种罕见但灾难性的并发症，常导致大量上消化道出血和高死亡率。虽然大多数病例发生在术后早期，但延迟出现的情况仍了解甚少。我们报告一例54岁女性患者，因食管中段鳞状细胞癌接受了食管切除术和胃上提术。术后9个月，患者出现呕血、失血性休克，尽管进行了复苏努力仍死亡。尸检发现降主动脉有一处0.9厘米的糜烂，胃管道相邻处有溃疡，并有细菌浸润，符合胸段AEF。该病例说明了经尸检分析证实的AEF罕见的延迟表现。它强调即使是最初恢复未出现并发症的患者也需要持续的临床警惕。
