Abstract
A case of an aortoesophageal fistula in a 61-year-old woman who underwent thoracic endovascular aortic repair and subtotal esophagectomy is presented. The patient had a history of left hemiplegia caused by a brain hemorrhage. She suddenly vomited blood at dinner and was taken to a local hospital. Though emergency endoscopic examination was performed, it revealed only mucosal erosion and constriction of the middle portion of the esophagus. The endoscopic fiber scope could not be inserted through the constriction. She was admitted to the hospital for further examination. Enhanced computed tomography (CT) showed a ruptured descending aortic aneurysm (maximal diameter, 40 mm) and aortoesophageal fistula. The middle portion of the esophagus was conpressed between the ascending aorta and descending aortic aneurysm. Just before leaving for our hospital, she vomited large amounts of blood. When she arrived at our hospital, she was intubated tracheally and transfused with large amounts of blood. Since open surgery entailed a high risk, endovascular surgery was performed to control the bleeding. Emergency thoracic endovascular aortic repair was performed, and a ready-made stentgraft (Gore TAG®) was deployed at the ruptured site. Since there was concern about the perforated esophagus being a source of infection, subtotal esophagectomy and omental flap transposition were performed at a later date. Postoperative CT showed no endoleaks. Respiratory failure persisted, and a tracheotomy was performed. After surgery, an antibiotic (ceftazidime) was administered, and fosfluconazole was added later because Candida glabrata was detected from the tip of the thoracic drainage tube. No symptoms of infection appeared. She was transferred to a local hospital on postoperative day 42. Four months later, she was re-admitted, and a retrosternal gastric bypass operation was performed successfully.
