BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology imp...BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.展开更多
Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated w...Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents(SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwenta computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.展开更多
BACKGROUND Aortoesophageal fistula(AEF)induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat.Although the current view suggests that endovascular stent-graf...BACKGROUND Aortoesophageal fistula(AEF)induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat.Although the current view suggests that endovascular stent-graft treatment is useful for AEF,whether a subsequent thoracic operation is necessary remains controversial.The purpose of this report is to describe our experience using endovascular stentgraft treatment without combined thoracic operations for the treatment of AEF in two specific cases.CASE SUMMARY We presented two cases of patients complaining of retrosternal discomfort treated in our department for an aortoesophageal fistula caused by the accidental ingestion of a fishbone.The two patients were effectively managed with combined means of endoscopic,medical(broad-spectrum antibiotic therapy,fasting,gastrointestinal decompression,etc.)and endovascular stent-graft treatment.The main difference in treatment was that the first patient presented with hematemesis after endoscopic removal of the fishbone.Subsequently,the patient underwent endovascular stent-graft treatment.The second case was managed with endoscopic removal of the fishbone with simultaneous endovascular stent-graft treatment,without any signs of hematemesis or melena.Both patients had successful postoperative management and were discharged home.Long-term follow-up is ongoing.CONCLUSION The treatment decision-making process should depend on the patients’specific situations.Our practice indicates that endovascular stent-graft treatment without combined thoracic operations could be a valuable alternative in selected patients.展开更多
BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The...BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 h.He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior.He had a past medical history of advanced esophageal cancer.He received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm.According to the symptoms and imaging findings,AEF was our primary consideration.The patient underwent aortic angiography,which indicated AEF and descending aortic pseudoaneurysm.Emergency percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after TEVAR.He received antibiotics and was discharged after treatment.However,he died 2 mo after the TEVAR due to cancer progression.CONCLUSION Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.展开更多
Aortoesophageal fistula(AEF)is a rare cause of massive upper gastrointestinal hemorrhage.Thoracic aortic aneurysm,esophageal foreign body,esophageal cancer and post-surgical complications are common causes of AEF;howe...Aortoesophageal fistula(AEF)is a rare cause of massive upper gastrointestinal hemorrhage.Thoracic aortic aneurysm,esophageal foreign body,esophageal cancer and post-surgical complications are common causes of AEF;however,AEF induced by radiation therapy is a rare phenomenon and seldom described in the literature.It is a catastrophic condition which requires rapid implementation of resuscitative measures,broad-spectrum antibiotics and surgical or endovascular intervention.Transthoracic endovascular aortic repair(TEVAR)is a newer and less invasive technique,which helps to achieve rapid hemostasis in patients with severe hemodynamic instability and offers advantages over conventional repair of the aorta in emergency situations.However initial TEVAR should be followed up with a more definitive surgical repair of the aorta and the esophagus,to lower the mortality rate and achieve better outcomes.We describe here a case of a seventyyear-old male who presented with massive upper gastrointestinal bleeding due to AEF induced by radiation therapy,and his subsequent successful initial management with TEVAR.展开更多
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XK-A36)the Key Research and Development Program of Zhejiang Province (2019C03076).
文摘BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.
基金Supported by The Deanship of Scientific Research at King Saud University funding of this research through the Research Group Project,No.RGP-VPP-279
文摘Bariatric surgeries have been used in an effort to curtail the obesity epidemic. The type of surgery used has changed over time, with sleeve gastrectomies being one of the preferred options. This has been associated with some complications, including staple line leaks. We report a 43-year old female who had undergone a laparoscopic sleeve gastrectomy that was complicated by a proximal gastric pouch leak at the gastroesophageal junction. We used self-expandable stents(SEMS) in the management of the leak. Seven weeks after the insertion of the initial SEMS, the patient presented with a massive gastrointestinal bleed that could not be localized due to profuse bleeding. The patient underwenta computerized tomography angiogram and then an angiogram that could not localize the site of the bleed. An emergency laparotomy was performed and identified the source of bleeding to be an aortoesophageal fistula. A graft of the diseased area was attempted but the patient unfortunately did not survive the procedure. An aortoesophageal fistula after an esophageal SEMS insertion for a benign disease has rarely been reported and only in cases where there was a thoracic neoplasm, thoracic aortic aneurism, endovascular stent repair, foreign body or esophageal surgery. To our knowledge, this is the first case that reports an aortoesophageal fistula as a result of a SEMS for the management of a gastric pouch leak after a laparoscopic sleeve gastrectomy.
文摘BACKGROUND Aortoesophageal fistula(AEF)induced by esophageal fishbones is a rare complication of esophageal foreign bodies and is very difficult to treat.Although the current view suggests that endovascular stent-graft treatment is useful for AEF,whether a subsequent thoracic operation is necessary remains controversial.The purpose of this report is to describe our experience using endovascular stentgraft treatment without combined thoracic operations for the treatment of AEF in two specific cases.CASE SUMMARY We presented two cases of patients complaining of retrosternal discomfort treated in our department for an aortoesophageal fistula caused by the accidental ingestion of a fishbone.The two patients were effectively managed with combined means of endoscopic,medical(broad-spectrum antibiotic therapy,fasting,gastrointestinal decompression,etc.)and endovascular stent-graft treatment.The main difference in treatment was that the first patient presented with hematemesis after endoscopic removal of the fishbone.Subsequently,the patient underwent endovascular stent-graft treatment.The second case was managed with endoscopic removal of the fishbone with simultaneous endovascular stent-graft treatment,without any signs of hematemesis or melena.Both patients had successful postoperative management and were discharged home.Long-term follow-up is ongoing.CONCLUSION The treatment decision-making process should depend on the patients’specific situations.Our practice indicates that endovascular stent-graft treatment without combined thoracic operations could be a valuable alternative in selected patients.
基金Supported by the Natural Science Foundation of Zhejiang Province (No. LQ19H030002)
文摘BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 h.He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior.He had a past medical history of advanced esophageal cancer.He received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm.According to the symptoms and imaging findings,AEF was our primary consideration.The patient underwent aortic angiography,which indicated AEF and descending aortic pseudoaneurysm.Emergency percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after TEVAR.He received antibiotics and was discharged after treatment.However,he died 2 mo after the TEVAR due to cancer progression.CONCLUSION Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.
文摘Aortoesophageal fistula(AEF)is a rare cause of massive upper gastrointestinal hemorrhage.Thoracic aortic aneurysm,esophageal foreign body,esophageal cancer and post-surgical complications are common causes of AEF;however,AEF induced by radiation therapy is a rare phenomenon and seldom described in the literature.It is a catastrophic condition which requires rapid implementation of resuscitative measures,broad-spectrum antibiotics and surgical or endovascular intervention.Transthoracic endovascular aortic repair(TEVAR)is a newer and less invasive technique,which helps to achieve rapid hemostasis in patients with severe hemodynamic instability and offers advantages over conventional repair of the aorta in emergency situations.However initial TEVAR should be followed up with a more definitive surgical repair of the aorta and the esophagus,to lower the mortality rate and achieve better outcomes.We describe here a case of a seventyyear-old male who presented with massive upper gastrointestinal bleeding due to AEF induced by radiation therapy,and his subsequent successful initial management with TEVAR.
