Penetrating Aortic Ulcer with Esophageal Fistulization: A New Etiology with a Different Treatment? A Case Report

Background: Penetrating aortic ulcers rupturing into the esophagus are rare and the resulting aortoesophageal fistula carries high mortality. With the progressive increase of life expectancy and with the expansion of the prevalence of risk factors for atherosclerosis, we are witnessing a multiplication of this condition. The emergency nature of this situation and its complex treatment makes the latter not consensually defined. Objectives: The aim of this study is to report two cases of aortoesophageal fistula and their alternative treatment, documenting the success of the method. Results: We present two cases of elderly patients, with no conditions for conventional surgery, who presented with acute gastrointestinal hemorrhage (hematemesis). The diagnosis of aortoesophageal fistula was suggested during upper gastrointestinal endoscopy and confirmed with computed tomography angiography. The two patients were submitted to endovascular stent graft repair of the aortoenteric fistula. A Ryle's tube was introduced and its position in the stomach was confirmed through fluoroscopy. Contrary to the common practice, no active surgical intervention was carried out for the esophageal lesion. Total parenteral nutrition was begun in the immediate postoperative period and both patients were maintained on broad-spectrum antibiotic coverage. They were discharged with enteric nutrition through the Ryle's tube and under antibiotic coverage. Consecutive upper gastrointestinal endoscopies revealed a reduction of the fistula's diameter until their complete closure. The patients remained under antibiotic coverage and initiated oral nutrition, with no significant events to be reported. Conclusion: The cases of penetrating aortic ulcer with esophageal fistulization are becoming more prevalent. Hence, it is essential to raise awareness about this subject, to provide the patient the best possible treatment. Thus, the report of similar cases is of major importance. Currently, the authors believe that this type of treatment option can be used in selected patients, that otherwise would not survive a conventional surgery.

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Artikel online veröffentlicht:
26. April 2021