A Case of Aortoesophageal Fistula due to Penetration of False Aortic Aneurysm

Yoshihisa Watanabe, Masayuki Matsumori, Masahiko Nakamura, Kazuo Nakamura

Surgery Division II, Kobe University School of Medicine

We experienced a rare case of aortoesophageal fistula due to intraesophageal rupture of a false aortic aneurysm. A 70-year-old woman was admitted another hospital because of hematemesis on September 2, 1990. Barium examination, endoscopy and computed tomography were performed and she was diagnosed as having advanced esophageal cancer with aortic invasion. However biopsied specimens from the esophageal lesion showed no malignancy. She was referred to our hospital on September 20. Esophageal endoscopy on that day revealed blood clot at top of a submucosal tumor in the left-posterior wall 25 cm from the incisors. She complained of hematemesis and tarry stool once more at dawn of the next day. On the fifth day after admission, she underwent an urgent thoracic esophagectomy through a right thoracotomy. Massive bleeding occurred during dissection of the tumor from the aortic wall after exposure and mobilization of the thoracic esophagus and she suffered shock. Bleeding with ordinary procedures. Replacement of 8 cm of the descending aorta with artificial graft, was performed under an aortic cross-clamp. The patient died of arrhythmias on the 9th day after the operation. Pathological analysis revealed thrombus protruding from the descending aorta into the lumen of the esophagus and round wall defects in the esophagus (2.5 cm in diameter) and aorta (1 cm in diamter). The cause of the false aneurysm was not found.

Key words
aortoesophageal fistula, false aortic aneurysm, esophageal bleeding

Reprint requests
Yoshihisa Watanabe Surgery Division, II, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
November 20, 1991

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