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A, B. Computed tomography images of fistula between aorta and esophagus (arrow) and free air surrounding aortic stent-graft (arrowhead). A, axial image. B, coronal image. C. Upper gastrointestinal endoscopy shows ulcer on left lateral wall of upper thoracic esophagus (arrow).
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Contrast-enhanced computed tomography at that time identified a fistula between the esophagus (Fig. 1A and B) and an aortic aneurysm, and upper gastrointestinal endoscopy revealed an esophageal ulcer (Fig. 1C).
Clinical course of the patient with aortoesophageal fistula after thoracic endovascular aortic repair.
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We planned a three-step surgical approach (Fig. 2).
Intraoperative and gross findings of fistula.. A: Intraoperative findings of fistula in aortic wall after esophageal resection (arrow). Blood oozed only from fistula.. B: Gross findings of esophagus show fistula with maximum diameter of 1.0 cm (arrow).
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Intraoperative findings revealed extensive inflammation of the mediastinal tissue and leakage of infected old blood from the aortic fistula without massive bleeding (Fig. 3A). Gross findings of the resected esophagus showed a perforation site with a maximum diameter of 1.0 cm (Fig. 3B).