American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2016, 4(12), 378-383
DOI: 10.12691/ajmcr-4-12-3
Open AccessCase Report

Endovascular Treatment of Aortoesophageal Fistula Caused by Ingestion of a Fragment of Beef Bone: Case Report and Review of the Literature

Sidinéia Santos da Rocha1, Carlos Eduardo Nunes2, Osmar Max Gonçalves Neves1, Vinícius de Oliveira Menezes Bezerra1 and José Aderval Aragão3,

1Medical Resident in the “Dr. José Calumby Filho” Vascular Surgery Service, Fundação Beneficência Hospital Cirurgia, Aracaju, Sergipe, Brazil

2Head of the “Dr. José Calumby Filho” Vascular Surgery Service, Fundação Beneficência Hospital Cirurgia, Aracaju, Sergipe, Brazil

3Department of Morphology and the Postgraduate Applied Health Science Programs, Federal University of Sergipe (UFS), and Titular Professor of the Medical School, Tiradentes University (UNIT), Aracaju, Sergipe, Brazil

Pub. Date: December 24, 2016

Cite this paper:
Sidinéia Santos da Rocha, Carlos Eduardo Nunes, Osmar Max Gonçalves Neves, Vinícius de Oliveira Menezes Bezerra and José Aderval Aragão. Endovascular Treatment of Aortoesophageal Fistula Caused by Ingestion of a Fragment of Beef Bone: Case Report and Review of the Literature. American Journal of Medical Case Reports. 2016; 4(12):378-383. doi: 10.12691/ajmcr-4-12-3

Abstract

Context: Aortoesophageal fistula is a rare but catastrophic complication that can occur either primarily or after aortic reconstruction. Because of its rarity, no standardized protocols for its diagnosis and treatment have been established. Objective: The objective of this study was to report on a case of aortoesophageal fistula caused by a fragment of beef bone, which was treated by means of an endoprosthesis in the descending thoracic aorta to control the bleeding. Case report: A 72-year-old female patient was initially admitted to the emergency service of a public hospital with dysphagia and intense pain in the dorsal region after having ingested a fragment of beef bone. Upper digestive endoscopy was performed to remove the foreign body. Nine days after the patient had been released, she was again admitted to the emergency service with back pain, voluminous hematemesis and signs of hypovolemia. Emergency angiotomography was performed, which revealed the presence of a pseudoaneurysm in the thoracic aorta just below the aortic arch that was suggestive of an aortoesophageal fistula. The patient was taken to the hemodynamics center and underwent an endovascular procedure to insert an endoprosthesis into the descending thoracic aorta, to control the bleeding. She was released after a hospital stay of 94 days, without further signs of infection or aortic bleeding. She evolved without symptoms during a follow-up of around 30 days, but then returned to the emergency service with persistent fever and signs of sepsis. She underwent left thoracotomy for drainage and debridement, but her condition worsened and she died during the immediate postoperative period. Conclusion: Aortoesophageal fistula is a serious clinical condition that needs to be dealt with early on, because of the risk of severe blood loss. Endovascular treatment is very important in this regard, since it promotes control over bleeding through an efficient and less invasive approach.

Keywords:
aortoesophageal fistula esophageal foreign body endovascular stenting upper gastrointestinal hemorrhage abdominal aortic aneurysm endoscopy

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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