Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2206-2215
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2206
Endovascular stent-graft treatment for aortoesophageal fistula induced by an esophageal fishbone: Two cases report
Hang Gong, Wei Wei, Zhong Huang, Ying Hu, Xian-Li Liu, Zhen Hu
Hang Gong, Wei Wei, Zhong Huang, Zhen Hu, Department of Gastroenterology, Zigong First People's Hospital, Zigong 643000, Sichuan Province, China
Ying Hu, Department of Gastroenterology, Luzhou People's Hospital, Luzhou 646000, Sichuan Province, China
Xian-Li Liu, Department of Ultrasound, Zigong TCM Hospital, Zigong 643000, Sichuan Province, China
Author contributions: Gong H and Wei W conceived of the study, designed it, and acquired the data; Gong H participated in the design of the study, coordination, and analysis of the data; Gong H and Wei W drafted the manuscript; Huang Z, Hu Y, Liu XL and Hu Z participated in the manuscript preparation and critical revision; all authors read and approved the manuscript.
Informed consent statement: Consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hang Gong, MMed, Doctor, Department of Gastroenterology, Zigong First People's Hospital, No. 42 Shangyihao Road, Zigong 643000, Sichuan Province, China. 343311398@qq.com
Received: October 10, 2021
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
Abstract
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 stent-graft 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.

Keywords: Aortoesophageal fistula; Foreign body; Esophagus; Endovascular treatment; Case report

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.