Endovascular stent-graft treatment for aortoesophageal fistula induced by an esophageal fishbone: Two cases report

Table 1 Cases involving endovascular treatment of aortoesophageal fistula or other aortic injury secondary to foreign body

No.	Sex	Age	Foreign body	Signs of infection	Aortal injury	Esophagoscopy	Surgical Management	The time interval between endovascular treatment and thoracic operations	Prognosis
Case 1	Male	22 yr	Chicken bone	WBC count of 19.96 × 109/L	CTA demonstrated a mediastinal esophageal fistula with an aortic pseudoaneurysm at the descending aorta	Esophageal stent-graft was implanted to isolate the esophageal perforation followed by the placement of a three-lumen gastrojejunal tube	Two F16 silicone tubes were placed in the pleural cavity and the mediastinum to facilitate postoperative drainage after mediastinal debridement and irrigation using the thoracoscope.	Immediately	Succeseeful salvage
Case 2	Male	32 yr	Fishbone	No abnormalities	CTA demonstrated an AEF	Emergency gastroscopy could not identify a bleeding focus due to massive amounts of clot and fresh blood	The esophagus was primarily repaired and reinforced by a pedicled intercostal muscle flap to cover the exposed stent-graft through a right thoracotomy	Immediately	Succeseeful salvage
Case 3	Male	59 yr	Fishbone	Evidence of sepsis with a high fever and hypotension	CTA demonstrated an AEF	There was some active bleeding after the fishbone was removed by gastroscopy	The stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest, and reconstitution of the gastrointestinal tract	53 d	Succeseeful salvage
Case 4	Male	25 yr	Fishbone	WBC count of 15.7 × 109/L	CTA demonstrated a large aortic pseudoaneurysm was seen on the descending aorta but not a punctured aorta	Not done	Two drainage tubes were placed in the left thoracic cavity and the mediastinum after the pseudoaneurysm was opened and mediastinal debridement and irrigation were performed by exploratory thoracotomy	Immediately	Succeseeful salvage
Case 5	Male	79 yr	Goat bone	WBC count of 12.4 × 109/L with a high fever	CTA demonstrated the presence of a focal irregularity of the aortic medial profile at the level of the thoracic aorta, suspected for an adventitial tear	The bone fragment was endoscopically removed and an endoscopic closure of the esophageal laceration by means of 2 long clips was performed.	Not done	Not done	Succeseeful salvage
Case 6	Male	40 yr	Chicken bone	WBC count of 10.9 × 109/L	CTA demonstrated an AEF and a large saccular pseudoaneurysm at the aortic isthmus, accompanied by mediastinal hematoma and bilateral pleural effusion	Esophagoscopy showed fresh and clotted blood coming from two irregular mural ulcers in the upper and middle thirds of the esophagus	After careful debridement, the dead space between the aorta and esophagus was filled with a viable pedicle flap of the omentum by an exploratory left thoracotomy. Two chest tubes were placed for mediastinal irrigation and drainage	Immediately	Succeseeful salvage
Case 7	Female	80 yr	Not mentioned	Elevated WBC count and MRSA-positive blood cultures	CT demonstrated a thoracic aorta aneurysm and an AEF	A mass was compressing the distal third of the esophagus, and an ulcer was present. An esophageal stent was placed to cover the whole esophagus	Not done	Not done	Died 3 months after the thoracic aorta stent was placed
Case 8	Male	58 yr	Duck bone	Not mentioned	CTA confirmed a descending intramural hematoma	The duck bone was removed gently using an endoscope	Not done	Not done	Succeseeful salvage

WBC: White blood cell; AEF: Aortoesophageal fistula; CTA: Computed tomography angiography; CT: Computed tomography; MRSA: Methicillin-resistant staphylococcus aureus.