Two-staged Surgical Strategy of Aortoesophageal Fistula Due to Rupture of Dissecting Aneurysm of the Descending Thoracic Aorta: Definitive Aortic Repair Followed by Esophageal Reconstruction

Abstract

There have been only a few survivors who underwent repair surgery for aortoesophageal fistula (AEF) because preoperative acute circulatory failure and postoperative infection carry a poor risk. Especially, AEF due to rupture of dissecting aortic aneurysm is really rare. Herein, we report on a patient who was successfully treated with surgery for AEF due to chronic dissecting aortic aneurysm. A 60 year-old-woman with a history of type B aortic dissection at the age of 51 was admitted to our hospital with hematemesis and melena. A contrast computed tomography (CT) showed a dissecting aortic aneurysm 68 mm in diameter and esophageal compression. She was diagnosed with AEF because contrast medium was stored in the esophagus and stomach. We performed replacement of the descending thoracic aorta with a prothetic graft, omentopexy, and esophagectomy emergently. Esophageal reconstruction as secondary procedure was performed 63 days later. Thereafter, her postoperative course was uneventful and she was discharged on the 23rd day after the secondary procedure.