Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2206
Peer-review started: October 10, 2021
First decision: November 11, 2021
Revised: November 21, 2021
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: March 6, 2022
Processing time: 142 Days and 16 Hours
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 stent-graft treatment without combined thoracic operations for the treatment of AEF in two specific cases.
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.
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.
Core Tip: Esophageal foreign body is the most common cause of aortoesophageal fistula. Aortoesophageal fistula is easily confused with other upper gastrointestinal bleeding, and it is very dangerous and has serious consequences. In this work, we presented two cases of perforation of esophagus due to foreign body and analyzed the 8 similar cases recorded in PubMed, MEDLINE from January 2000 to October 2021. This pooled analysis of involving endovascular stent-graft treatment of aortoesophageal fistula or other aortic injury secondary to foreign body, in view of clinical course, imaging, treatment and prognosis may provide a better understanding of aortoesophageal fistula.