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Eur J Cardiothorac Surg 2009;35:365-367. doi:10.1016/j.ejcts.2008.09.049
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Case reports

Secondary infection of a pre-existing thoracic aortic aneurysm by iatrogenic oesophageal perforation with aorta-oesophageal fistula formation

Yiu Che Chana,*, Albert C. Tinga, Simon Lawb, Stephen W. Chenga

a Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong
b Division of Oesophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong

Received 21 July 2008; received in revised form 29 September 2008; accepted 30 September 2008.

* Corresponding author. Tel.: +852 2855 4962; fax: +852 2855 4961. (Email: ycchan88{at}hkucc.hku.hk).

We report a case of iatrogenic perforation of the oesophagus, with subsequent infection of a pre-existing thoracic aortic aneurysm and development of an aorto-oesophageal fistula resulting in life-threatening haemorrhage. This was successfully treated with endovascular aortic stent-graft using a Cook Zenith Tx2® device. Follow-up CT scan 3 months later showed that the aneurysm sac is getting smaller, and patient had no further septic or haemorrhagic complications. However, we emphasise that even if initial endovascular management of aorto-oesophageal fistula is successful, these patients often risk recurrent sepsis and therefore long-term clinical and radiological surveillance is mandatory.

Key Words: Iatrogenic oesophageal perforation • Thoracic aortic aneurysm • Aorto-oesophageal fistula • Endovascular aneurysm stent-graft






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Copyright © 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.