Cases reported "Aortic Diseases"

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1/64. Successful surgical treatment of aortogastric fistula after an esophagectomy and subsequent endovascular graft placement: report of a case.

    An aortogastric fistula is a rare but fatal complication after an esophagectomy and intrathoracic esophagogastric anastomosis. A 54-year-old man underwent an esophageal resection due to carcinoma in his lower esophagus. The alimentary tract continuity was restored by intrathoracic esophagogastric anastomosis. Forty-six days later, he suffered a massive hematemesis due to an aortogastric fistula which had formed at the esophagogastric suture line. The fistula was surgically obliterated twice, but each operation was followed by pseudoaneurysm formation. The patient was finally successfully treated with an endovascular stent graft placement. This is the first report of a patient surviving after developing this complication.
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ranking = 1
keywords = esophagus
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2/64. Combined resection of the thoracic esophagus and thoracic descending aorta.

    We conducted combined resection of the thoracic esophagus and thoracic descending aorta in 2 patients, one with advanced esophageal cancer with aortic invasion and the other aortoesophageal fistula caused by a false aortic aneurysm. Combined resection of esophageal tumor and adjacent involved organs was conducted in 14 patients with A3:T4 esophageal cancer but none survived 3 years and resecting tumor-invaded organs did not improve patient survival. One major problem of combined resection of the esophagus and aorta is contamination of the posterior mediastinum. In 1 patient, 2-stage surgery for the esophagus and in situ aortic replacement was conducted to reduce operative risk and avoiding infection of the prosthetic vascular graft. With thoracic descending aortic aneurysm adjacent to the esophagus on the increase, cardiovascular surgeons should prepared to undertake combined resection of both the aorta and esophagus.
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ranking = 9
keywords = esophagus
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3/64. Aortoesophageal fistula caused by aneurysm of the thoracic aorta: successful surgical treatment, case report, and literature review.

    Aortoesophageal fistula induced by atherosclerotic thoracic aortic aneurysm is rare, but is usually a fatal disorder, with few survivors reported. We report the case of a 72-year-old man with aortoesophageal fistula successfully treated in a two-stage operation. In the first stage, we performed resection and replacement of the aortic aneurysm with a prosthetic graft in situ, esophagectomy, cervical esophagostomy, and jejunostomy. After the patient recovered well postoperatively, a transmediastinal retrosternal interposition of the stomach was performed, with esophagogastroanastomosis in the cervical area, to re-establish the gastrointestinal tract. We include a discussion of the causes, diagnostic approach, management of the aorta and esophagus, and review of the literature.
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ranking = 1
keywords = esophagus
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4/64. Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation.

    A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.
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ranking = 2
keywords = esophagus
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5/64. Primary aortoesophageal fistula: presenting as massive upper gastrointestinal hemorrhage.

    Primary aortoesophageal fistula is a rare cause of upper gastrointestinal bleeding. A six-year-old boy presented with massive upper gastrointestinal hemorrhage. endoscopy revealed a submucosal bulge in the esophagus with an ulcer and clot at the top. Lateral skiagram of the chest showed a posterior mediastinal mass. CT scan of the chest revealed a ruptured aortic aneurysm into the oesophagus, confirmed the diagnosis. The patient succumbed to the illness before he could be subjected to definitive treatment.
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ranking = 2
keywords = esophagus
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6/64. Fatal hemorrhage complicating carcinoma of the esophagus. Report of four cases.

    Four cases of esophageal carcinoma complicated by fatal hemorrhage are reported. All four patients had recently completed radiation therapy. An aortoesophageal fistula was present in two cases; fibrinoid necrosis of the esophageal arteries was present in the other two. The esophageal tumor was localized in two cases and had disappeared in one case. In one patient it had metastasized widely. Ninety-nine other reports of esophageal cancer and fatal hemorrhage are reviewed from the literature. Aortoesophageal fistula was the cause of hemorrhage in 78 cases. Occlusion of the vasa vasorum by thrombosis, inflammation, neoplastic cells or radiation injury appears to be the cause of aortic necrosis and fistula formation. Prompt surgical approach, if possible, should be used to control hemorrhage, as the primary tumor may be localized to the esophagus only.
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ranking = 5
keywords = esophagus
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7/64. Primary aorto-oesophageal fistula due to oesophageal carcinoma. Report of a successfully managed case.

    Aorto-oesophageal fistula is a rare but often fatal entity causing upper gastrointestinal bleeding. Amongst the different aetiologies described, the commonest is rupture of a thoracic aortic aneurysm into the oesophagus. This entity was first reported in 1818, and only recently have successfully treated cases been published. Other causes such as postoperative complications, tuberculosis and trauma are less common. Oesophageal malignancy perforating the aorta is a rarity. The authors describe a case of aortic perforation secondary to an oesophageal carcinoma, treated with initial success. The clinical onset was a massive upper gastrointestinal haemorrhage. The diagnosis, once the bleeding was controlled, was arrived at after CT-scanning and arteriography. A Dacron prosthesis was interposed into the descending thoracic aorta to restore aortic flow; later an oesophagectomy plus oesophagostomy and jejunostomy were carried out.
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ranking = 1
keywords = esophagus
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8/64. aortic aneurysm involving a right-sided arch complicating aortobronchopulmonary and aortoesophageal fistula.

    A 66-year-old man with hemoptysis, chest pain, fever, and hoarseness was admitted to our department. A right-sided aortic arch and three aneurysms in the proximal arch, distal arch, and descending aorta were confirmed by aortography and surgery. Fistula formations were discovered between the proximal arch aneurysm and the right upper lobe (aortobronchopulmonary fistula: ABF), and between the descending aorta and the esophagus (aortoesophageal fistula: AEF). Concomitant ABF and AEF are very rare. Aortopulmonary and/or aortoesophageal fistula complicated by a right-sided aortic arch have not been previously reported.
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ranking = 1
keywords = esophagus
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9/64. Successful management of an aortoesophageal fistula resulting from an aneurysm of the thoracic aorta with a covered stent.

    Aortoesophageal fistula (AEF) is a relatively rare but life-threatening cause of upper gastrointestinal bleeding. There have been only a few survivors previously reported. There are controversies particularly regarding the treatment of the esophagus and postoperative infections. We report a case of an elderly man with an aortoesophageal fistula resulting from a thoracic aortic aneurysm. We managed the replacement of the aorta using a prosthetic graft, and an omentopexy for the fistula of the esophagus. For the treatment of leakage of the esophageal fistula, we successfully used a covered stent. This is the first report of the management of AEF using a covered stent.
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ranking = 2
keywords = esophagus
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10/64. Fatal Hemorrhage following perforation of the aorta by a barb of the Gianturco-Rosch esophageal stent.

    Self-expanding metal stents are an established option in the palliative treatment of malignant stenoses of the esophagus. Herein, we report on a 60-year-old man with a recurrent stenosis that developed 2 months after radiochemotherapy for a squamous cell carcinoma in the middle part of the esophagus. To relieve progressive dysphagia, a Gianturco-Rosch stent (Cook-Z stent, 10 cm, PE-covered, manufactured by William Cook europe) was implanted. Six weeks later, precipitous massive hemoptysis leading to the collapse and death of the patient occurred. autopsy showed that a barb in the middle of the stent had perforated the aortic arch, resulting in massive bleeding into the gastrointestinal tract, and aspiration. Although hemorrhage and esophageal perforation are known late complications of all types of metal stents, our case is the first description of a perforation involving a fixation barb. These barbs are a particular feature of the European version of the Cook-Z stent, and are intended to prevent stent migration. In future, any hemorrhage observed after stent implantation should prompt a search for perforation by a barb (autopsy!). If necessary, the European version of the Gianturco Z stent should be modified.
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ranking = 2
keywords = esophagus
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