Management options for aorto-oesophageal fistula: case histories and review of the literature

• Published in: Perfusion 2013-07, Vol.28 (4), p.286-290
• Main Authors: Göbölös, L, Miskolczi, S, Pousios, D, Tsang, GM, Livesey, SA, Barlow, CW, Kaarne, M, Shambrook, J, Lipnevicius, A, Ohri, SK
• Format: Article
• Language: English
• Subjects: Aorta - pathology; Aorta - surgery; Aortic Diseases - complications; Aortic Diseases - pathology; Aortic Diseases - surgery; Aortic Diseases - therapy; Esophageal Fistula - complications; Esophageal Fistula - pathology; Esophageal Fistula - surgery; Esophageal Fistula - therapy; Esophagus - pathology; Esophagus - surgery; Gastrointestinal Hemorrhage - etiology; Humans; Vascular Fistula - complications; Vascular Fistula - pathology; Vascular Fistula - surgery; Vascular Fistula - therapy
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1177/0267659113476329

Objective: An aorto-oesophageal fistula is a rare clinical entity, leading to life-threatening gastrointestinal bleeding. Thoracic aortic aneurysms are the most common cause of aorto-oesophageal fistulae; further causes involve foreign body ingestion, trauma (in most cases iatrogenic), carcinoma or, very rarely, aortitis tuberculotica. Methods: Due to its rarity, there are no large multicentre studies present to evaluate the efficacy of different therapeutic management options. Since it is associated with significant morbidity and mortality, we give a short summary of various treatment approaches performed in our clinical practice in the past three years. The most straightforward therapeutic option may be an endovascular aortic repair and subtotal oesophageal resection followed by gastro-oesophageal reconstruction, but other alternative treatment possibilities are also present, although with probable higher morbidity. Conclusions: Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach.