A two-stage reconstruction for aortoesophageal fistula after replacement of thoracic aorta for Stanford Type B dissecting aortic aneurysm: esophagectomy and a double-tract reconstruction using the pedicled jejunum: a case report and literature review

An aortoesophageal fistula (AEF) is a rare, potentially fatal condition, and esophagectomy is usually performed simultaneously with aortic surgery. However, esophageal reconstruction method has not been established. This case report describes a two-stage operation for AEF after replacement of thorac...

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Bibliographic Details
Published in:Clinical journal of gastroenterology 2020-10, Vol.13 (5), p.722-727
Main Authors: Sato, Sho, Kunisaki, Chikara, Tanaka, Yusaku, Sato, Kei, Miyamoto, Hiroshi, Yukawa, Norio, Nemoto, Hiroko, Uchida, Keiji, Nishii, Teppei, Kosaka, Takashi, Akiyama, Hirotoshi, Endo, Itaru
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aorta, Thoracic - diagnostic imaging
Aorta, Thoracic - surgery
Aortic Aneurysm - surgery
Blood Vessel Prosthesis Implantation - adverse effects
Case Report
Colorectal Surgery
Esophagectomy
Gastroenterology
Hepatology
Humans
Jejunum - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Surgical Oncology
Vascular Fistula - etiology
Vascular Fistula - surgery
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Summary:An aortoesophageal fistula (AEF) is a rare, potentially fatal condition, and esophagectomy is usually performed simultaneously with aortic surgery. However, esophageal reconstruction method has not been established. This case report describes a two-stage operation for AEF after replacement of thoracic aorta for Stanford Type B dissecting aortic aneurysm. A 61-year-old man who had underwent total arch replacement with frozen elephant trunk for Stanford Type B dissecting aortic aneurysm 3 years ago admitted to the hospital with high fever. Based on the computed tomography and endoscopic findings, he was diagnosed with having aortoesophageal fistula (AEF). After administration of antibiotics with fasting foods and drinks for a month, he underwent the second aortic replacement, thoracic esophagectomy, cervical esophagostomy, gastrostomy and omental wrapping. After 3 months, he underwent double-tract reconstruction using the pedicled jejunal transfer with supercharge and superdrainage via the subcutaneous route. After reconstruction surgery, the patient was doing well. Two-stage reconstruction was a safe procedure for AEF case who underwent aortic replacement, esophagectomy and omental wrapping. The pedicled jejunum reconstruction via subcutaneous route is an optional procedure for second reconstruction surgery.
ISSN:1865-7257
1865-7265
DOI:10.1007/s12328-020-01158-9