Song Conghua, Peng Jianyang, Xu Huiyuan, Li Xiaomei
Gastrointestinal Endoscopy Center, The Affiliated Hospital of Putian University, Putian, China.
Department of Interventional and Vascular Surgery, The Affiliated Hospital of Putian University, Putian, China.
Front Med (Lausanne). 2025 Sep 10;12:1624035. doi: 10.3389/fmed.2025.1624035. eCollection 2025.
Gastric squamous cell carcinoma (GSCC) arising within a gastric conduit is an exceedingly rare phenomenon, and its presentation as a gastro-aortic fistula has never been documented. This case highlights the diagnostic challenges and life-threatening potential of delayed aortoenteric complications after esophagectomy, and underscores the evolving role of endovascular therapy in emergent hemorrhage control.
A 75-year-old male presented with 6 h of recurrent, high-volume hematemesis and presyncope. On arrival, he was hypotensive (74/50 mmHg), tachycardic, and profoundly anemic (hemoglobin 64 g/L). Physical examination revealed marked conjunctival pallor but a soft, non-tender abdomen without signs of portal hypertension.
Emergent computed tomography angiography demonstrated contrast extravasation from the posterior wall of the gastric conduit into the descending thoracic aorta. Digital subtraction angiography confirmed a focal gastro-aortic fistula at the T6 level. Under angiographic guidance, thoracic endovascular aortic repair (TEVAR) was performed using a COOK ZTEG-2PT-30-200 covered stent graft, achieving immediate hemostasis. The patient received massive transfusion support (22 units packed red cells, 8 units cryoprecipitate, 2,000 ml fresh frozen plasma) alongside proton pump inhibitors and somatostatin. Two days post-repair, endoscopic biopsy of the conduit ulcer edge confirmed squamous cell carcinoma. The patient recovered without further bleeding and was discharged day 10 in stable condition. A multidisciplinary tumor board recommended adjuvant chemoradiotherapy. The patient and family opted for palliative care following oncologic consultation due to the advanced disease stage and overall clinical context.
In late post-esophagectomy patients presenting with massive upper gastrointestinal bleeding, high clinical suspicion for arterioenteric fistula is warranted. Computed tomography angiography and DSA should precede endoscopy in hemodynamically unstable patients. TEVAR offers a minimally invasive, rapid means of hemorrhage control, serving as a critical bridge to definitive cancer management.
胃管道内发生的胃鳞状细胞癌（GSCC）极为罕见，其表现为胃主动脉瘘的情况尚未见文献记载。本病例突出了食管切除术后迟发性主动脉肠并发症的诊断挑战和危及生命的可能性，并强调了血管内治疗在紧急出血控制中不断演变的作用。
一名75岁男性出现反复大量呕血6小时并伴有晕厥前症状。入院时，他血压低（74/50 mmHg）、心动过速且严重贫血（血红蛋白64 g/L）。体格检查发现结膜明显苍白，但腹部柔软、无压痛，无门静脉高压体征。
诊断、干预与结果：急诊计算机断层血管造影显示造影剂从胃管道后壁渗入降主动脉。数字减影血管造影证实T6水平有局灶性胃主动脉瘘。在血管造影引导下，使用COOK ZTEG - 2PT - 30 - 200覆膜支架移植物进行了胸段血管内主动脉修复（TEVAR），实现了即刻止血。患者接受了大量输血支持（22单位浓缩红细胞、8单位冷沉淀、2000 ml新鲜冰冻血浆），同时使用质子泵抑制剂和生长抑素。修复术后两天，对管道溃疡边缘进行内镜活检确诊为鳞状细胞癌。患者康复且未再出血，于第10天病情稳定出院。多学科肿瘤委员会建议进行辅助放化疗。由于疾病分期较晚和整体临床情况，患者及家属在肿瘤咨询后选择了姑息治疗。
对于食管切除术后晚期出现大量上消化道出血的患者，应高度怀疑动脉肠瘘。对于血流动力学不稳定的患者，计算机断层血管造影和数字减影血管造影应先于内镜检查。TEVAR提供了一种微创、快速的出血控制方法，是确定性癌症治疗的关键桥梁。
